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Full text of "Diagnostic cost group (DCG) and hierarchical coexisting conditions (HCC) models for Medicare risk adjustment"

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HEALTH ECONOMICS RESEARCH, INC. 



300 Fifth Avenue, 6th Floor 
Waltham, MA 02154 
(617)487-0200 
(017)487-0202 -FAX 



DIAGNOSTIC COST GROUP (DCG) AND 

HIERARCHICAL COEXISTING CONDITIONS (HCC) 

MODELS FOR MEDICARE RISK ADJUSTMENT 

Volume II 

Appendices to Final Report 

Submitted by ; 

RandaU P. EUis, Ph.D.^ 

Gregory C. Pope, M.S.2 

Lisa I. lezzoni, M.D., M.Sc.^ 

John Z. Ayanian, M.D., M.P.P.^ 

David W. Bates, M.D., M.Sc.5 

Helen Burstin, M.D., M.P.H.^ 

Debra A. Dayhoff, Ph.D7 

Amy Rensko, B.A.^ 

Tim Dawes, B.A.^ 

Arlene S. Ash, Ph.D.9 



AffiliaHons : ^Senior Economist, Health Economics Research, Inc., Waltham, MA and Professor of Economics, 

Boston University, Boston, MA 
^Vice President, Health Economics Research, Inc., Waltham, MA 
^Associate Professor of Medicine, Harvard Medical School, Division of General Medicine and Primary Care, 

Department of Medicine, Beth Israel Hospital, the Charles A. Dana Research Ir\stitute, and the Harvard- 

Thomdike Laboratory, Boston, MA 
^Assistant Professor of Medicine, Harvard Medical School, and Department of Health Care Policy, 

Brigham and Women's Hospital, Boston, MA 
^Assistant Professor of Medicine, Harvard Medical School, and Division of General Medicine, 

Brigham and Women's Hospital, Boston, MA 
^Instructor in Medicine, Harvard Medical School, and Division of General Medicine, Brigham and 

Women's Hospital, Boston, MA 

Seiuor Economist, Health Economics Research, Inc., Waltham, MA 
*Jimior Analyst, Health Economics Research, Inc., Waltham, MA 

Associate Research Professor, Health Care Research Uiut, Boston University School of Medicine, Boston, MA 

April 26, 1996 



9 



This report is submitted under Contract No. 500-92-0020, Delivery Order No. 6, with the Health Care Financing Administration. 
Total funding for this project was $589,692, which was 100 percent Federal funds. The views and opinions expressed in this report 
are the authors'; no endorsement by HCFA or DHHS is intended or should be inferred. The contractor assumes responsibUity lor the 
accuracy and completeness of information in this report. We would like to acknowledge the contributions to this project, and thank, 
the foUowing individuals: Mel higher, HCFA Project Officer; Robert Baker and Fizza GiUani, HER Programmer/ Analysts; and 
Angela Merrill and Monika Reti, HER Junior Analysts. 



TABLE OF APPENDICES 



APPENDIX A: DCG Project Key Personnel and Consultants 

APPENDIX B: Diagnostic Group (DXGROUP) Definitions and Prospective Statistics 

TABLE B-1 DXGROUP Diagnostic Categories with ICD-9-CM Codes 

TABLE B-2 1992 Medicare Program Expenditures and 1991 Frequency of Enrollees for 

Principal Inpatient Diagnostic Groups (Upper Case Labels) and Hospital and 
Physician (All) Diagnostic Groups (Lower Case Labels) 

TABLE B-3 Regression of 1992 Medicare Program Expenditures on 1991 Hospital and 

Physician (AU) Diagnosis Diagnostic Groups 

APPENDIX C: Diagnostic Cost Group Sorting Algorithm Results 

TABLE-C-1 Sorting Algorithm Output for Principal Inpatient DCG Model 

TABLE C-2 Sorting Algorithm Output for Hospital and Physician (All) Diagnosis DCG 
Model 

TABLE C-3 Sorting Algorithm Output for Expanded DCG Model (Principal Inpatient 

Diagnoses are in Upper Case) 

TABLE C-4 Sorting Algorithm Output for Expanded DCG Model with Procedures 
(Principal Inpatient Diagnoses are in Upper Case) 

TABLE C-5 Sorting Algorithm Output for Concurrent Principal Inpatient DCG Model 

TABLE C-6 Sorting Algorithm Output for Concurrent Hospital and Physician (AU) 

Diagnosis DCG Model 

APPENDIX D: Life-Sustaining Procedure DefiniHons 

TABLE D-1 'Life-Sustaining' Procedures (5-Digit Nimibers are CPT-4 Codes) 

APPENDIX E: Diagnostic Cost Groups by Diagnostic Category (DXGROUP) 

TABLE E-1 Diagnostic Cost Groups by Diagnostic Category, for Alternative DCG 

Models 



dcg\ f inal\ toc-appn.doc\nab 



TABLE OF APPENDICES 
(continued) 



APPENDIX F: Prospective Hierarchical Coexisting Condition Models 

TABLE F-1 Prospective Hierarchical Coexisting Conditions (HCCs) 



TABLE F-2 

TABLE F-3 
TABLE F-4 



Hierarchical Coexisting Conditions, Procedures and Hospitalizations, 
and Augmented Hierarchical Coexisting Conditions, Payment Models 

Hierarchical Coexisting Conditions Classification Models 

Estimated Prospective HCC Payment Model Parameters for Aged and 
Disabled Subsamples 



APPENDIX G: Geographic Input Price Index 

TABLE G-1 Alternative Geographic Adjustment Factors by Metropolitan Area: 

Geographic Input Price Index (GIPI) and Components, and Indexed 
Medicare Capitation Payment (lAAPCC) 



APPENDIX H: Concurrent Diagnostic Group (DXGROUP) and Hierarchical Coexisting 
Conditions Statistics 



TABLE H-1 

TABLE H-2 

TABLE H-3 
TABLE H-4 



1992 Medicare Program Expenditures and 1992 Frequency of Enrollees for 
Concurrent Principal Inpatient Diagnostic Groups (Upper Case Labels) and 
Hospital and Physician Diagnostic Groups (Lower Case Labels) 

Regression of 1992 Medicare Program Expenditures on 1992 Hospital and 
Physician (All) Diagnosis Diagnostic Groups 

Concurrent Hierarchical Coexisting Conditions (HCCs) 

Hierarchical Coexisting Conditions Concurrent Model Parameter Estimates 



APPENDIX I: Specialty Codes Considered Physician Specialties 

TABLE I-l 1991 Specialty Codes Considered Physician Specialties 



dcg\f inal\ toc-appn.doc\nab 



ii 



APPENDIX A: 

DCG PROJECT KEY PERSONNEL 
AND CONSULTANTS 



APPENDIX A: DCG PROJECT KEY PERSONNEL AND CONSULTANTS 



HEALTH ECONOMICS RESEARCH, INC. SENIOR STAFF 



PRINCIPAL INVESTIGATOR: 

TITLE: 

AFFILIATION: 

MAILING ADDRESS: 

TELEPHONE NOS.: 
FAX NO.: 
E-MAIL: 



RANDALL P. ELLIS, PH.D. 

Professor of Economics 

Economics Department, Boston University 

270 Bay State Road 

Boston, MA 02215 

BU: (617) 353-2741; HER: (617)487-0200; 

(617) 353-4449 

ellisrp@acs.bu.edu or randy@her-cher.org 



PROJECT DIRECTOR: 
TITLE: 

AFFILIATION: 
MAILING ADDRESS: 



TELEPHONE NO. 
FAX NO.: 
E-MAIL: 



GREGORY C. POPE, M.S. 
Vice President 

Health Economics Research, Inc. 
Health Economics Research, Inc. 
300 Fifth Avenue, Sixth Floor 
Waltham, MA 02154 
(617) 487-0200, Ext. 134 
(617) 487-0202 
Greg@her-cher. org 



H.E.R. STAFF: 
TITLE: 

AFHLIATION: 
MAILING ADDRESS: 



TELEPHONE NO.: 
FAX NO.: 
E-MAIL: 



DEBRA A. DAYHOFF, PH.D. 
Senior Economist 
Health Economics Research, Inc. 
Health Economics Research, Inc. 
300 Fifth Avenue, Sixth Floor 
Waltham, MA 02154 
(617) 487-0200, Ext. 142 
(617) 487-0202 
DebbieD@her-cher. org 



A-1 



dcg\fmal\key-pers.doc\nab-apr.l996 



HARVARD MEDICAL SCHOOL FHYSICL^N CONSULTANTS 



CONSULTANT: 
SPECIALTY: 
TITLE: 

AFHLIATION: 
MAILING ADDRESS: 



TELEPHONE NO.: 
FAX NO.: 
E-MAIL: 



JOHN Z. AYANIAN, M.D., M.P.P. 

Internal Medicine 

Assistant Professor of Medicine, Harvard Medical School 

Brigham and Women's Hospital 

Brigham and Women's Hospital 

Department of Health Care Policy 

Harvard Medical School 

25 Shattuck St., Parcel B, First Floor 

Boston, MA 02115 

(617) 732-7464; 

(617) 432-0173 

ayanian@elixir.med.harvard.edu 



CONSULTANT: 
SPECIALTY: 
TITLE: 

AFHLIATION: 
MAILING ADDRESS: 



TELEPHONE NO.: 
FAX NO.: 
E-MAIL: 



DAVID W. BATES, M.D., M.Sc. 

Internal Medicine 

Assistant Professor of Medicine, Harvard Medical School 

Brigham and Women's Hospital 

Division of General Medicine, A-2 

Brigham and Women's Hospital 

75 Francis Street 

Boston, MA 02115 

(617) 732-7063 

(617) 732-7072 

dwbates@bics.bwh.harvard.edu 



CONSULTANT: 
SPECIALTY: 
TFILE: 

AFHLIATION: 
MAILING ADDRESS: 



TELEPHONE NO. 
FAX NO.: 
E-MAIL: 



HELEN BURSTIN, M.D. 

Internal Medicine 

Instructor in Medicine, Harvard Medical School 

Brigham and Women's Hospital 

Division of General Medicine 

Brigham and Women's Hospital 

75 Francis Street 

Boston, MA 02115 

(617) 732-7063 

(617) 732-7072 

hburstin@bics.bwh.harvard.edu 



A-2 



dcg\final\key-pers.doc\nab-apr.l996 



HARVARD MEDICAL SCHOOL PHYSICIAN CONSULTANTS (continued) 



CONSULTANT: 
SPECIALTY: 
TITLE: 
AITILIATIONS: 

MAILING ADDRESS: 



TELEPHONE NO.: 
FAX NO.: 
E-MAIL: 



LISA lEZZONI, M.D., M.Sc. 

General Medicine/ Health Services Research 

Associate Professor of Medicine, Harvard Medical School 

Beth Israel Hospital, The Charles A. Dana Research Institute 

and The Harvard-Thomdike Laboratory 

General Medicine 

Beth Israel Hospital, LY-326 

330 Brookline Avenue 

Boston, MA 02215 

(617) 667-5871 

(617) 667-4926 

liezzoni@bih.harvard.edu 



PHYSICL\N SPECIALIST CONSULTANTS 



CONSULTANT: 

SPECIALTY: 

TITLE: 

MAILING ADDRESS: 

TELEPHONE NO.: 
FAX NO.: 
E-MAIL: 



SCOTT STROUP, M.D., M.P.H. 

Psychiatry 

Research Fellow, J.F. Kennedy School of Government; 

Clinical Fellow in Psychiatry, Cambridge Hospital 

28 Cambridge Terrace 

Cambridge, MA 02140 

(617) 868-4353 

(617) 496-9053 



CONSULTANT: 

SPECIALTY: 

TITLE: 

AFHLIATION: 
MAILING ADDRESS: 



TELEPHONE NO. 
FAX NO.: 
E-MAIL: 



HOWARD LEIBOWITZ, M.D. 

Ophthalmology 

Chairman & Professor, Department of Ophthalmology; 

Ophthalmologist in Chief at University Hospital 

Boston University School of Medicine 

80 E. Concord Street 

Suite L907 

Boston, MA 02118 

(617) 638-4550 

(617) 638-5337 



A-3 



dcg\fmal\key-pers.doc\nab-apr.l996 



PHYSICIAN SPECIALIST CONSULTANTS (continued) 



CONSULTANT: 
SPECIALTY: 
TITLE: 

AFHLIATION: 
MAILING ADDRESS: 



TELEPHONE NO. 
FAX NO.: 
E-MAIL: 



RENEE ROSSI, M.D. 

Otolaryngology 

Clinical Instructor of Otolaryngology, Harvard Medical School 

Deaconess Hospital 

Harvard Medical School 

Department of Otolaryngology 

Deaconess Hospital 

110 Francis Street 

Boston, MA 02215 

(617) 632-7340 

(617) 632-1086 



PHYSICIAN REVIEWERS 



CONSULTANT: 
SPECIALTY: 
TITLE: 

AFFILIATION: 
MAILING ADDRESS: 



TELEPHONE NO.: 
FAX NO.: 
E-MAIL: 



WILLIAM STEPHEN AARON, M.D. 

General Surgery 

Clinical Assistant Professor of Surgery 

University of LouisviUe School of Medicine 

Aaron & Walker, P.S.C. 

801 Barret Avenue 

Suite 116 

Louisville, KY 40204 

(502) 583-6241 

(502) 589-7912 



CONSULTANT: 

SPECIALTY: 

TITLE: 

AFHLIATION: 
MAILING ADDRESS: 



TELEPHONE NO. 
FAX NO.: 
E-MAIL: 



DEBORAH ALLEN, M.D. 

Family Practice 

Professor & Chairman, 

Department of Family Medicine 

Indiana University School of Medicine 

Indiana Uruversity School of Medicine 

1110 West Michigan 

Long Hospital 

Indianapolis, IN 46202 

(317) 278-0300 

(317) 274-4444 



AA 



dcg\final\key-pers.doc\nab-apr.l996 



PHYSICIAN RFVIEWERS (continued) 



CONSULTANT: 

SPECIALTY: 

TITLE: 

AITILIATION: 
MAILING ADDRESS: 



TELEPHONE NO. 
FAX NO.: 
E-MAIL: 



CHARLES CLARK, M.D. 

Endocrinology 

Co-Director, Regenstrief Institute; 

Professor of Medicine & Pharmacology 

Indiana University School of Medicine 

Regenstrief Health Center 

Indiana University School of Medicine 

1001 West Tenth Sta-eet 

Indianapolis, IN 46202 

(317) 630-6374 

(317) 630-6962 

Cclark@regen. rg. iupui.edu 



CONSULTANT: 
SPECIALTY: 
TITLE: 

AFHLIATION: 
MAILING ADDRESS: 



TELEPHONE NO. 
FAX NO.: 
E-MAIL: 



MAGRUDER C. DONALDSON, M.D. 

Vascular Surgery 

Associate Professor of Surgery 

Brigham and Women's Hospital/ Harvard Medical School 

Department of Surgery, Division of Vascular Surgery 

Brigham and Women's Hospital 

75 Francis Street 

Boston, MA 02115 

(617) 732-6624; (617) 732-6918 

(617) 730-2876 

mcdonaldso@bich.bwh.harvard.edu 



HEALTH SERVICES RESEARCH CONSULTANTS 



CONSULTANT: 
TITLE: 



AFFILIATION: 
MAILING ADDRESS: 



TELEPHONE NO. 
FAX NO.: 
E-MAIL: 



ARLENE ASH, PH.D. 

Associate Research Professor, 

Boston University Medical School & 

School of Public Health 

Boston University School of Medicine 

Boston University School of Medicine 

Health Care Research Unit 

720 Harrison Avenue 

Suite 1102 

Boston, MA 02118 

(617) 638-8818 

(617) 638-8026 

aash@acs.bu.edu 



A-5 



dcg\fmal\key-pets.doc\nab-apr.l996 



HEALTH SERVICES RESEARCH CONSULTANTS (continued) 



CONSULTANT: 
TITLE: 

AITILIATION: 
MAILING ADDRESS: 



TELEPHONE NO. 
FAX NO.: 
E-MAIL: 



CHRISTOPHER TOMPKINS, PH.D. 
Senior Research Associate 
Brandeis University 
Brandeis University 
415 South Street 
Waltham, MA 02154 
(617) 736-3913 
(617) 736-3905 



MEDICAL CODING CONSULTANTS 



CONSULTANT: 
AFFILIATION: 
MAILING ADDRESS: 



TELEPHONE NO. 
FAX NO.: 
E-MAIL: 



GERRY BERENHOLZ, RRA, MPH 
Berenholz Consulting Associates 
Berenholz Consulting Associates 
Health Record Information 
Management & Education Service 
27 Locke Lane 
Lexington, MA 02173 
(617) 862-2700 



CONSULTANT: 
AFHLIATION: 
MAILING ADDRESS: 

TELEPHONE NO.: 
FAX NO.: 
E-MAIL: 



BARRY LIBMAN, R.R.A., CCS. 
Independent Medical Coding Consultant 
196 Cherry Street 
Maiden, MA 02148 
(617) 322-8968 



A-6 



dcg\final\key-pers.dcx:\nab-apr.l996 



APPENDIX B: 

DIAGNOSTIC GROUP (DXGROUP) 
DEFINITIONS AND PROSPECTIVE STATISTICS 



TABLE B-1 

DXGROUP DIAGNOSTIC CATEGORIES WITH ICD-9-CM CODES 



DX GROUP 
NUMBER DX GROUP LABEL 

INFECTIOUS AND PARASITIC DISEASES 

1 CENTRAL NERVOUS SYSTEM INFECTION (E.G.. MENINGITIS. ENCEPHALITIS) 



ICD-9-CM CODES 



013, 045-049. 094. 320-325 



SEPTICEMIA/SHOCK 



038. 785.59 



HIV/AIDS (INCLUDING PNEUMOCYTOSIS) 



042-044. 136.3 



OTHER INFECTIOUS AND PARASITIC DISEASES 

4.01 bacterial enteritis (intestinal infections) 

4.02 viral enteritis (intestinal infections) 

4.03 other intestinal infections 

4.04 tut)erculosis 

4.05 strep ttiroat/scartet fever 

4.06 other bacterial infections 

4.07 tiacterial infection in other diseases 

4.08 herpes zoster (shingles) 

4.09 herpes simplex 

4.10 viral hepatitis 

4. 1 1 other viral infections 

4. 12 late syphilis, symptomatic 

4.13 dermatophytosis (fungal skin infections, e.g.. athlete's foot) 

4.14 thrush 

4.15 mycoses (fungal diseases), miscellaneous 

4.16 other infections 



003. 004, 008, 008.(K)08.5 
008.6, 008.8 

001. 005. 006. 007, 009 
010-012, 014-018 
034.034.0,034.1 

002, 020^27. 030^)33. 035^337. 039-040 
041 

053 

054 

070,573.1.573.2 

050-052, 055-057, 060-066. 071-079 

093,095 

110, 111 

112.0 

112.2, 112.4, 112.5, 112.8, 114-117 

080-088, 09CM)92, 096 097, 097.0, 097.1, 097.9, 098-104. 112, 112.3. 
112.9. 118. 120-136, 1360, 1361, 1364. 136.5 1368, 1369 



LATE EFFECTS 



LATE EFFECTS 

5.01 infection late effects 

5.02 cerebrovascular disease late effects 
5 03 injury late effects 



137-139. 326 
438 
905-909. E929 



MALIGNANT NEOPLASM 



f^OUTH/PHARYNXflJVRYNX/OTHER RESPIRATORY CANCER 

6.01 cancer of mouth/tongue 

6.02 cancer of pharynx 

6.03 cancer of larynx 

6.04 other respiratory/intrathoracic cancer 



141-145 

146-149 

161 

160. 164. 165 



STOI^ACH/SMALL BOWEL/LIVER/PANCREAS/ESOPHAGUS CANCER 

7.01 cancer of esophagus 

7.02 cancer of stomach 

7.03 cancer of small bowel/peritoneum 

7.04 cancer of liver 

7 05 cancer of pancreas 

7.06 other, unspecified cancer of digestive organs/peritoneum 



ISO 

151 

152, 156, 158 

155 

157 

159 



1 

(jcgMinaf\appx-XVTab-b 1 Viab 



TABLE B-1 

DXGROUP DIAGNOSTIC CATEGORIES WITH 1CD-9-CM CODES 



DX GROUP 
NUMBER 



DX GROUP LABEL 



ICD-9-CM CODES 



COLON CANCER 



RECTAL CANCER 



1S3 
tS4 



10 



LUNG CANCER 



162, 163 



BREAST CANCER 



174, 175 



12 HODGKIN'S DISEASE/LYMPHOMA/MYELOMA/LEUKEMIA 

12.01 lymphoma/Karposi's sarcoma/Hodgkin's Disease 

12.02 multiple myeloma 

12.03 lymphoid leukemia 

12.04 myeloid leukemia 

12.05 other leukemia 



176, 200-202 

203 

204, 204.0-204.2, 204.8, 204 9 

205 

206-208 



13 CANCER OF UTERUS/CERVIX/FEMALE GENITAL ORGANS 

13.01 cancer of uterus 

13.02 cancer of cervix/female genital organs 



179, 182 

180. 184 



14 



CANCER OF PLACENTA/OVARY/UTERINE ADNEXIA 



181, 183 



15 CANCER OF PROSTATEATESTIS/t^ALE GENITAL ORGANS 

15.01 prostate cancer 

15.02 cancer of testis/male genital organs 



185 
186, 187 



16 



CANCER OF BLADDER«IDNEY/URINARY ORGANS 



188, 189, 189.0-189.4, 189 8, 1899 



17 NEOPLASM OF NERVOUS SYSTEM 

17.01 cancer of the eye 

17.02 cancer of the brain/nervous system/pituitary, pineal glands 

17.03 benign neoplasm brain/nervous system/pituitary, pineal glands 



190 

191, 192, 194.3, 194.4 

225, 227.3, 227.4 



18 OTHER CANCER 

18.01 cancer of bone and articular cartilage 

18.02 cancer of connective and other soil tissue 

18.03 melanoma 

18.04 skin cancer, except melanoma, including lip 

18.05 thyroid/endocrine cancer 

1 8.06 other/ill-defined site cancer 



170 
171 

172 

140, 173, 232 

193, 194, 194.0, 194.1, 194.5, 194.6. 194.8, 194.9, 259.2 

195. 199, 199.1 



19 SECONDARY CANCERS 

19.01 secondary cancer of lymph node 

19.02 secondary cancer of respiratory and digestive systems 

19.03 secondary cancer of other site 

19.04 disseminated cancer 



1S6 
197 
198 
199.0 



dcg>finalNappx-x\Tab-ti1Viab 



TABLE B-1 

DXGROUP DIAGNOSTIC CATEGORIES WITH ICD-9<;M CODES 



DX GROUP 
NUMBER 

BENIGN NEOPLASM, CARCINOMA IN SITU 



DX GROUP LABEL 



ICD-9-CM CODES 



20 BENIGN NEOPLASMS 

20.01 benign neoplasm of digestive system 

20.02 benign neoplasm of respiratory system 

20.03 benign neoplasm of skin 

20.04 tjenign neoplasm of breast/other breast disorders 

20.05 benign neoplasm of urinary 
20 06 benign neoplasm of eye 
20.07 other benign neoplasms 

21 CARCINOMA IN SITU/NEOPLASM OF UNCERTAIN BEHAVIOR 

21 .01 carcinoma in situ of digestive organs 

21 .02 carcinoma In situ of respiratory system 

21.03 carcinoma in situ of ottier sites, except skin 

21.04 neoplasm of uncertain betiavior, specified sites 

21 .05 neoplasm of uncertain behavior nec/nos 

21.06 unspecified neoplasm 



210,211 

212 

216 

217. 610. 611 

223 

224 

213-215. 218-222, 226. 227, 227.0, 227 1, 227.5, 227.6, 227 8, 227 9, 
228, 229, 229.0, 229.8, 229.9 



230 

231 

233, 234 
235-237 
238 
239 



ENDOCRINE. NUTRITIONAL, AND METABOLIC DISEASES 



22 



DIABETES WITHOUT COMPLICATIONS 



250, 250.0, 251.3 



23 



DIABETES WITH ACUTE COMPLICATIONS 



250.1-250.3 



24 DIABETES WITH CHRONIC COMPLICATIONS 

24.01 diabetes with renal manifestation 

24.02 diabetes with other specified complications 

24.03 diabetes with unspecified complications 



250.4 

250.6-250.8 
250.9 



25 HYPOGLYCEMIA 

25.01 hypoglycemic coma 

25.02 other hypoglycemia 



251.0 
251.1. 251.2 



26 



DISORDERS OF FLUID/ELECTROLYTE/ACID BASE BALANCE 



276 



27 OTHER ENDOCRINEffJUTRITIONAL/METABOLIC DISEASES 

27.01 goiter 

27.02 thyrotoxicosis. Including Graves' disease 

27.03 thyroid disorders 

27.04 adrenal gland disorders, e.g.. Cushing's syndrome 

27.05 ovarian dysfunction 

27.06 testicular dysfunction 

27.07 other endocrine disorders 

27.08 pituitary/parathyroid/thymus/polyglandular disorders 

27.09 protein-calorie malnutrition 

27.10 vitamin/other nutritional deficiencies (e.g.. rickets, scurvy) 

27. 1 1 disorders of lipoid metabolism (high cholesterol) 



240. 241 

242 

243-246 

2SS 

256 

257 

259. 259.0. 259.1. 259.3, 259 4, 259.8, 259.9 

251.4. 251.5. 252-254. 258 

260-263, 799.4 

264-271 

272 



dcg\/inal\appx-x\Tab-b1Viab 



TABLE B-1 

DXGROUP DIAGNOSTIC CATEGORIES WITH ICD-9-CM CODES 



DX GROUP 
NUMBER 



DX GROUP LABEL 



27.12 disorders of plasma protein metabolism 

27.13 disorders of mineral metat)olism 

27.14 cystic fibrosis, metabolism disorders, nec/nos 

27.15 other hyperalimentation 

27.16 obesity/localized adiposity 



ICD-a-CM CODES 

273 
275 

277 

278. 278 2, 278.3, 278 4, 278 8 

278.0, 278.1 



GASTROINTESTINAL DISORDERS 



28 PANCREATITIS/ OTHER PANCREATIC DISORDERS 

28.01 acute pancreatitis 

28.02 chronic pancreatitis/other pancreatic diseases/intestinal malabsorption 



577.0 

251, 251.8. 251.9, 577, 577.1, 577.2, 577.8. 577.9, 579 



29 END STAGE LIVER DISORDERS 

29.01 end stage liver disorders 

29.02 esophageal varices 



570, 572.2, 572.3, 572.4, 572.8 
456.0, 456.1, 456.2 



30 OTHER LIVER DISORDERS 

30.01 cirrhosis 

30.02 other liver disorders, including toxic hepatitis 



571.2,571.3,571.5,571.6 

452, 571, 571.0, 571.1, 571.3, 571.4, 571.8, 571 9. 572. 572.0. 572.1. 
573. 573 0. 573.3. 573.4. 573.8. 573.9 



31 



DISEASES OF ESOPHAGUS 



530 



32 ULCERS 

32.01 ulcer without perforation 

32.02 ulcer with perforation 



531. 531.0. 531.3. 531,4, 531.7. 531.9. 532. 532,0. 532,3 532,4. 532.7. 
532.9. 533. 533.0. 533.3. 533.4. 533,7. 533.9. 534. 534.0, 534.3. 534.4. 
534.7. 534.9 

531.1, 531.2, 531.5, 531.6, 532.1, 532.2, 532.5, 532,6, 533,1, 5332. 
533.5, 533.6, 534.1, 534.2, 534.5, 534.6 



33 GASTRITIS/OTHER GASTRIC DISORDERS 

33.01 pyloric/duodenal obstaiction 

33.02 gastritis/other gastric disorder (stomach disorders) 



34 



APPENDICITIS 



537.0, 537.3 

535-537, 537.1, 537.2, 537.4, 537.5, 537.6, 537.8. 537.81-537.83, 
537.89. 537.9. 564. 787 

540-543 



35 



ABDOMINAL HERNIA/ COMPLICATED 



551.552 



36 



ABDOMINAL HERNIA/ UNCOMPLICATED 



550,553 



37 INFLAMMATORY BOWEL DISEASE 

37.01 regional enteritis (Crohn's disease) 

37.02 ulcerative colitis 



S6S 
SS6 



38 PERITONITIS/INTESTINAL OBSTRUCTION 

38.01 intestinal obstmction 

38.02 peritonitis 

38.03 other peritoneal disorders 



560 
567 
S68 



dcg\finaI^appx-x\Tab-b1^nab 



TABLE B-1 

DXGROUP DIAGNOSTIC CATEGORIES WITH ICD-9-CM CODES 



DX GROUP 
NUMBER 



DX GROUP LABEL 



39 



DIVERTICULA OF INTESTINE 



ICD.9-CM CODES 



562 



40 ANAURECTAL/GASTROINTESTINAL DISORDERS 

40.01 hemorrhoids 

40.02 anal/rectal disorders 

40.03 intestinal abcess/ulceration/perforation 

40.04 other intestinal disorders 



455 

565, 566. 569.0, 569.1, 569.2, 569 3, 569.4 

569.5 569.8 

558, 558.1, 558.2, 558.9. 569, 569.9 



41 GALLBLADDER DISORDERS 

41.01 cholelithiasis (gallstones) 

41.02 biliary tract disease 

41 .03 other gallbladder disorders 



574.2 

576.1-5765 576.8 

574, 574.0, 574.1, 574.3-574.5, 575, 576, 576.0, 576.9 



42 



GASTROINTESTINAL HEMORRHAGE 



578 



DISEASES OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE 



43 GOUT/ARTHROPATHY/DERANGEMENTS 

43.01 gout/crystal arthropathy 

43.02 other arthropathy/joint disorders, derangements, joint pain/stiffness 



274, 712 
713. 716-719 



44 CONNECTIVE TISSUE DISEASES 

44.01 systemic lupus erythematosus, scleroderma, arteritis, and other connective tissue disease 446, 710 

44 02 rheumatoid arthritis and other inflammatory polyarthropathy 714 

44.03 inflammatory spondylopathies 720 

44.04 polymyalgia rheumatica 725 



45 ARTHROPATHY/BONE INFECTION 

45.01 arthropathy with infection 

45.02 osteomyelitis 



711 
730 



4S 



OSTEOARTHRITIS 



715 



47 



BACK DISORDERS (E.G., HERNIATED DISC. LUMBAGO. SCIATICA. BACKACHE) 721-724 



48 



DISORDERS OF SOFT TISSUES (EG., TENDONITIS, BURSITIS) 



726-729 



49 OTHER BONE DISORDERS 

49.01 osteoporosis 

49.02 other bone disorders (e.g.. curvature of spine, Pagefs disease) 

49.03 flat fool, acquired deformities of toe 

49.04 other acquired limb deformities 



733.0.733.1 

731-733. 733.2-733.9, 737, 738 

734, 735 

736 



DISEASES OF BLOOD AND BLOOD-FORMING ORGANS 



50 



IRON DEFICIENCY AND OTHER/UNSPECIFIED ANEMIAS 



280, 281, 285 



SI OTHER BLOOD DISEASES 

51 .01 sickle cell and other hereditary hemolytic anemias 



282 



dcgVinal\appx-x\Tab-b1Viab 



TABLE B-1 

DXGROUP DIAGNOSTIC CATEGORIES WITH 1CD-9^M CODES 



DX GROUP 
NUMBER 



DX GROUP LABEL 



ICD-9-CM CODES 



51 .02 acquired hemolytic anemia 

51.03 aplastic anemia 

51.04 tiemophilia and ottier coagulation defects 

51.05 purpura/ttiromtxxiytopathy/tiemorrtiagic conditions 

51 .06 white blood cell disorders 

51.07 immune disorders 

51.08 other blood disease 



283 
284 
286 
287 
288 
279 
289 



MENTAL DISORDERS 



52 DEMENTIA 

52.01 senile/presenile psychoses 

52.02 other organic psychotic conditions 

52.03 cerebral degeneration/Alzheimer's disease/Reye's syndrome 

52.04 senility without psychosis 



290 
294 
331 
797 



53 SUBSTANCE-RELATED PSYCHOSES 

53.01 alcoholic psychoses 
53 02 dmg psychoses 



291 
292 



54 DELIRIUM/HALLUCINATIONS 

54.01 delirlum/delusions/hallucinations 

54.02 hallucinations, symptomatic 



293 
780.1 



55 



SCHIZOPHRENIC DISORDERS 



29S 



56 



MANIC AND DEPRESSIVE DISORDERS, INCLUDING MAJOR DEPRESSIVE DISORDE 296 



57 PARANOIA AND OTHER PSYCHOSES 

57.01 paranoid states 

57.02 other nonorganic psychoses 



297 
298 



58 



NEUROTIC DISORDERS 



300 



59 SUBSTANCE ABUSE AND DEPENDENCE 

59.01 alcohol dependence 

59.02 drug dependence 

59.03 non-dependent abuse of drugs 



303 
304 
30S 



60 OTHER MENTAL DISORDERS 

60.01 personality disorders 

60.02 sexual deviations and disorders 

60.03 psychophysiologic disorders 
60 04 acute reaction to stress 

60.05 adjustment reaction 

60.06 nonpsychotic organic brain syndrome 

60.07 depression, not elsewhere classified 

60.08 behavior disorder 

60.09 developmental tiehavioral disorders 



301 
302 
306 
308 
309 
310 
311 
312 
313-316, 995.5. 995.81, V40 



dcg\flnal\appx-x\Tab-b1Viab 



TABLE B-1 

DXGROUP DIAGNOSTIC CATEGORIES WITH ICD-9^M CODES 



DX GROUP 
NUMBER 



DX GROUP LABEL 



60.10 mental retardation 

60. 1 1 ottier mental disorders 



ICD-9-CM CODES 



317-319 



299, 307, 307.0-307.2, 307.20-307.23, 307.3, 307.4, 307.40-307.49, 
307.5,307.50-307.54, 307.59, 307.6-307.8, 307.80, 307.89, 307.9 



NEUROLOGICAL DISORDERS 



61 



HEADACHES 



307.81, 346, 784 



ea DEGENERATIVE NEUROLOGIC DISORDERS 

62.01 Parkinson's disease 332 

62.02 Huntington's Disease, essential tremor, ottier abnormal movement disorders 333 

62.03 anterior tiom cell disease, including Lou Gehrig's disease (ALS) 335 

62.04 ottier spinal cord disease 336 

62.05 autonomic nerve disorder 337 

62.06 Tay-Sachs, ottier hereditary and degenerative central nervous system diseases 330, 334 



63 OTHER NEUROLOGIC DISORDERS 

63.01 multiple sclerosis, other central nervous system dymelination 

63.02 infantile cerebral palsy 

63.03 quadriplegia 

63.04 paraplegia 

63.05 Cauda equina syndrome 

63.06 other paralytic disorders 

63.07 nervous/musculoskeletal system symptoms 

63.08 other central nervous system disorders 



340, 341 

343 

344.0 

344.1 

344.6 

344. 344.2-344.5. 344.8. 344.9 

781 

348, 349 



54 



EPILEPSY AND OTHER SEIZURE DISORDERS 



345, 7803 



65 MONONEUROPATHY 

65.01 trigeminal nerve disorders 

65.02 facial nerve disorder, including Bell's Palsy 

65.03 root/plexus disorders 
65 04 root/plexus lesions 

65.05 other cranial nerve disorders 

65.06 neuropathy of upper limb 

65.07 neuropathy of leg 

65.08 ottier neuropathy 



350 

351 

353, 353.8, 353.9 

353.1.353.4 

352, 352.0. 352.1. 352.2. 352.4, 352.5, 352.6, 352.9 

354 

355 

352.3, 353.0, 353.1, 353.2, 353.3, 353.5, 353.6 



66 POLYNEUROPATHY 

66.01 peripheral neuropathy 

66.02 inflammatoryrtoxic neuropathy, including Guillaln-Barre syndrome 

66.03 myoneural disorders/myasthenia gravis 

66.04 muscular dystrophies 



356 

357 
358 



67 



CEREBRAL CYSTS, COMPRESSION. EDEMA. ANOXIC DAMAGE. 
OTHER BRAIN CONDITIONS 



348.0-348.5. 348.8, 348 9 



dcg\flnai\appx-x\Tat}-b1Viab 



TABLE B-1 

DXGROUP DIAGNOSTIC CATEGORIES WITH ICD-9-CM CODES 



DX GROUP 
NUMBER 

CIRCULATORY DISORDERS 



DX GROUP LABEL 



ICD-9-CM CODES 



68 VALVULAR AND RHEUMATIC HEART DISEASE 

68.01 rheumatic fever/heart disease 

68.02 mitral or aortic valve/endocardia disease 

68.03 mitral/aortic valve disorders 



390-393, 397. 398 
394, 395, 424 



69 HYPERTENSION, UNCOMPLICATED 

69.01 essential hypertension 

69.02 hypertensive heart disease 



401,401.1,401.9 
402,402.1,402.9 



70 HYPERTENSION, COMPLICATED 

70.01 malignant hypertension 

70.02 malignant hypertensive heart disease 

70.03 hypertensive heart and renal disease 

70.04 secondary hypertension 

70.05 hypertension encephalopathy 



401.0 

402.0 

403,404 

405 

437.2 



71 MYOCARDIAL INFARCTION 

71.01 myocardial infarction 



71.02 old myocardial infarction 

71.03 other chronic ischemic heart disease 



410, 410,0. 41O00, 410.02. 410.1, 410.10, 410 12, 4102, 41O20. 
41022, 410.3, 41O30, 41032, 4104, 41040, 410 42, 4105, 
41050,410.52, 4106, 410.60, 410.62. 4107, 410.70, 41072, 4108, 
41080 410.82, 4109, 41O90, 410.92 

412 

414 



72 



ACUTE MYOCARDIAL INFARCTION (HEART ATTACK) 



41O01, 410.11, 41021, 410 31, 410.41, 41051, 410.61, 41071, 41081. 
41091, 429.5, 429.6 



73 



OTHER ACUTE ISCHEMIA 



411,411,1,411.8 



74 



ANGINA PECTORIS 



413 



75 PULMONARY HEART DISEASE 

75.01 pulmonary embolism (blood clot) 

75.02 other pulmonary heart disease 



4151 

415, 4150, 416, 417 



76 RHYTHM AND CONDUCTION DISORDERS 

76.01 conduction disorders/cardiac dysrhythmias 

76.02 premature heart beats 



426, 427, 427.8. 427.9 
427.6 



77 



ATRIAL ARRHYTHMIA 



427.0. 427.2, 427,3 



78 



VENTRICULAR TACHYCARDIA 



427.1 



79 



HEART ARREST/ SHOCK 



427.4, 427.5. 785.5, 785.50, 785.51, 798 



80 



HEART FAILURE 



428 



dcg^fi^ai^appx-x\Tab-b1V1ab 



TABLE B-1 

DXGROUP DIAGNOSTIC CATEGORIES WITH ICD-9-CM CODES 



DX GROUP 
NUMBER 



DX GROUP LABEL 



81 OTHER CARDIAC DISEASE 

81.01 acute pericarditis, post-myocardlal Infarction 

81.02 acute endo/myocarditis 

81.03 cardiomyopattiy/myocarditis 

81.04 cardiomegaly (enlarged heart) 

81 .05 olfier heart disease 



ICD-9-CIVI CODES 



411.0,420.423 

421, 422 

425, 429.0, 429.1 

429.3 

429, 429.4, 429.7-429.9 



82 



CEREBRAL HEMORRHAGE 



430-432 



83 



PRECEREBRAL ARTERIAL OCCLUSION 



433 



84 CEREBROVASCULAR DISEASE 

84.01 cerebrovascular accident (stroke) 

84.02 hemiplegia (paralysis of one side of Ixxly) 

84.03 aphasia (loss of language skills/comprehension) 



434, 436, 437, 437.0, 437.1. 437.3-437.9 

342 

784.3 



85 



TRANSIENT CEREBRAL ISCHEMIA 



435 



86 ATHEROSCLEROSIS 

86 01 atherosclerosis/arteriosclerosis of major vessel 

66. 02 atherosclerosis/general, arteriosclerotic cardiovascular disease/arteriosclerosis 



440.0-440.2 

429.2, 440. 440.8. 440 9 



87 ANEURYSM 

87.01 aortic aneurysm 

87.02 other aneurysm 



441 
442 



88 



ARTERIAL EMBOLISM AND THROMBOSIS 



444 



89 PERIPHERAL VASCULAR DISEASE 

89.01 specified peripheral vascular disease 

89.02 Raynaud's syndrome 

89.03 peripheral vascular disease 

89.04 other arterial disease 

89.05 disease of capillaries 

89.06 vascular InsufTiciency of intestines 

89.07 gangrene 



443.443 1.4438 

443.0 

443.9 

447 

448 

557 

785.4 



90 THROMBOPHLEBITIS 

90.01 phlebitis and thrombophlebitis 

90.02 noninfectious lymphatic disorders 

90.03 hemorrtiage nos 

90.04 compression of vein 



451, 451.1, 451.11, 451.19, 451.2, 451.8, 451.81. 451.89. 451.9. 453 

457 

459.0 

4SS.2 



91 



HYPOTENSION (LOV\/ BLOOD PRESSURE) 



458 



92 OTHER CIRCULftTORY DISEASE 

92.01 superficial phlebitis-leg 

92.02 varicose veins 

92.03 other circulatory disease/postphlebitic syndrome 



451.0 

454. 456. 456.3-456.6. 456 8 
459,459.1.459.9 



9 

dcgUtnal^appx-x^Tab-b1V1ab 



TABLE B-1 

DXGROUP DIAGNOSTIC CATEGORIES WITH ICD-9-CM CODES 



DX GROUP 

NUMBER 



DX GROUP LABEL 



92.04 other specified circulatory disorders 



ICD-9-CM CODES 



459.8 



DISORDERS OF THE EYE AND ADNEXA 



93 DISORDERS OF THE EYE AND ADNEXA 

93.01 diathetic retinopathy 

93.02 proliferative diabetic retinopathy 

93.03 endophthalmitis (eye inflammation) 

93.04 retinal disorders 



93.05 glaucoma 

93.06 cataract/lens replacement 

93.07 disorders of refraction and accommodation (e.g., far-, near-sightedness, astigmatism) 

93.08 vitreous hemorrhage 

93.09 other eye disorders 



250.5. 362.0, 362.01 

362.02 

360.0, 360.1 

361, 362.1, 362.10,-362.18, 362.2, 362.21, 362.29, 362 3, 362.30- 
362.37, 362.4, 362.40-362.43, 362.5, 362.50, 362.51-362.57, 362.6, 
362.60-362.66, 362.7, 362.70-362.77, 362.8, 362.81-362.85 362 89 
362.9 

365 

366, V431 

367 

379.23 

360, 3602-360.6, 360.8, 360.9, 363, 364, 368-379, 379.0, 379 00- 
379.09, 3791, 379.11-37916, 379.19, 379,2, 37921, 37922, 37924- 
379.26, 37929, 379.3, 379.31-379.34, 379,39, 379 4. 379 41-379,43. 
379.5, 379.50-379.59, 379,8, 379.9, 379.90-379.93 



DISORDERS OF THE EAR AND MASTOID PROCESS 



94 EAR DISORDERS 

94.01 impacted earwax 

94.02 otitis media (middle ear infection) 

94.03 vertiginous syndromes (eg., vertigo, Meniere's disease) 

94.04 hearing loss 

94. 05 other ear disorders 



380.4 

381, 382 

386 

389 

380, 380.0-380,3, 380,5, 380.8, 380,9, 383-385. 387, 388 



DISEASES OF THE RESPIRATORY SYSTEM 



95 NOSE/ THROAT DISEASES 

95.01 acute noseAhroat infection (eg. common cold) 

95.02 nasal polyps/allergic rhinitis (e.g., hay fever) 

95.03 chronic sinusitis 

95.04 larynx/vocal cord diseases 

95.05 paralysis of vocal cords/larynx 

95.06 disorders of teeth, gum, and jaw (e.g., periodontitis, gingivitis) 

95.07 other diseases of upper respiratory system 
95 08 salivary gland diseases 

95.09 other oral soft tissue/tongue/jaw disorders 



460-465, 475 

471, 477 

473 

476, 478 4, 478.5, 478.6, 478.7 

478.3 

520-526, 526.0-526.4, 526.8, 526.9 

470. 472. 474. 478, 478.0-478.2, 478 8, 478.9 

527 

526.5, 528. 529 



96 



EMPHYSEHflA/CHRONIC BRONCHITIS 



491.492,496,518.1,518 2 



97 



OTHER BRONCHITIS 



466,490 



VIRAL PNEUMONIA/INFLUENZA 

98.01 viral pneumonia 

98.02 influenza 



480 
487 



10 
dcg\rina^appx-x\Tab-b1^nab 



TABLE B-1 

DXGROUP DIAGNOSTIC CATEGORIES WITH ICD-9<;M CODES 



DX GROUP 
NUMBER 

99 



DX GROUP LABEL 

GRAM-NEGATIVE/STAPHYLOCOCCUS PNEUMONIA 



ICD-9-CIV1 CODES 



482.0, 482.1, 482.4, 482.8 



100 BACTERIAL PNEUMONIA 

100.01 pneumococcal and other specific bacterial pneumonia 

100.02 other and unspecified pneumonia 



431, 482, 482.3 
482.9, 483-486 



101 



ASTHMA 



102 LUNG DISEASES DUE TO EXTERNAL AGENTS 

102.01 bronchiectasis/lung diseases due to specified external agents (e.g., black lung disease) 494, 495, 500-506 

102.02 aspiration pneumonia 507 

102.03 respiratory conditions due to other and unspecified external agents/postinflammatory fibnos 508, 515 



103 



PLEURISY/PNEUMOTHORAX 



511, 512 



104 OTHER LUNG DISEASE 

104.01 empyema/abscess of lung 

104.02 pulmonary congestion/hypostasis 

104.03 acute lung edema nos 

104.04 post trauma/surgery pulmonary insufficiency 

104.05 other lung disease 



510, 513 

514 

S18.4 

518.5 

516-518, 5180, 5183, 519 



105 RESPIRATORY FAILURDARREST 

105.01 respiratoryfailure 

105.02 respiratory arrest 



518 8, 799.0 
799.1 



DISEASES OF THE GENITOURINARY SYSTEM 



106 RENAL FAILURE 

106.01 nephritis, dialysis encounter 

106.02 acute renal failure 

106.03 chronic renal failure 

106.04 renal failure, unspecified 

106.05 impaired renal function 



580-583, V56 

584 

585 

586 

587-589 



107 



KIDNEY INFECTION 



590 



108 



RENAUURETERAL/BLADDER CALCULUS 



592, 594 



109 OTHER RENAL/URETERAL DISEASES 

109.01 urethral stricture 

109.02 hydronephrosis/other renal/urethral disorders 



598 
591, 593 



110 



OTHER URINARY TRACT INFECTIONS 



595, 597, 599.0 



111 



OTHER URINARY DISORDERS 



596,599,599.1-599.9 



112 PROSTATE/TESTICULAR/PENILE DISORDERS 

112.01 hyperplasia of prostate 



600 



11 

dcgVinal\appx-x\Tat>-b1Viab 



TABLE B-1 

DXGROUP DIAGNOSTIC CATEGORIES WITH ICD-9<:M CODES 

DX GROUP 
NUMBER DX GROUP LABEL 

112.02 other prostatic disorders 

112.03 penis/testis/male genital organs disorders 



ICD-9-CM CODES 

601,602 

603-607, 607.0-607.3, 607.8, 607.9, 608, 608.0-608 4, 608.8. 608.9 



113 DISEASES OF FEMALE GENITAL ORGANS 

1 13.01 diseases of female pelvic organs 

1 13.02 vaginal and cervical diseases 

1 13.03 otfier diseases of female genital organs 

1 13.04 female stress incontinence 

113.05 menopausal and postmenopausal disorders 



614-616, 616.2-616.5, 616 8, 616 9. 617, 619-621 

112.1, 131, 616.0, 616.1. 622, 624 

623, 625, 625.0^5.5, 625.8. 625.9, 626, 628, 629 

6256 

627 



114 



GENITAL PROLAPSE 



618 



PREGNANCY-RELATED CONDITIONS 



115 PREGf^NCY/PERINATAL CONDITIONS 

115 01 pregnancy/birtti complications, mottier/child 

115.02 pregnancy witti alxjrtive outcome 

115.03 nonnal pregnancy/delivery 



630, 631. 640-648, 651-676, 760-779, V23. V31-V37 

632-639 

650, V22, V24, V27, V2S, V30. V39 



DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE 



116 DERMATOLOGICAL DISORDERS 

1 16.01 cellulitis/abscess/other local skin infection 

1 1 6.02 bullous dermatoses 



681-683, 686 
694 



117 



CHRONIC ULCER OF SKIN 



707 



118 OTHER DEMATOLOGICAL DISORDERS 

1 18.01 dermatitis due to substances taken internally (e.g., food, drugs) 

1 18.02 psoriasis and similar disorders 

1 18.03 other dermatosis 

118 04 diseases of nail (eg. Ingrown toenail) 

118.05 other dermatological disorders • 



693 



702 

703 



680, 684, 685, 690-692, 695, 697, 698, 700, 701, 704-706, 708. 709 



CONGENITAL ANOMALIES 



119 CONGENITAL ANOMALIES 

1 19.01 spina bifida, other congenital anomalies of nervous system 

1 19.02 congenital anomalies of eye 

1 19.03 congenital anomalies of cardiac/circulatory systems 

1 19.04 congenital anomalies of musculoskeletal/limb 

119.05 congenital anomalies of skin 

1 19.06 Down's syndrome and other chromosomal anomalies 

1 19.07 other congenital anomalies 



740-742 

743 

745-747 

754-756 

757 

758 

744, 748-753, 759 



12 

dcg^rinal^appx-x^T8t>b1\nab 



TABLE B-1 

DXGROUP DIAGNOSTIC CATEGORIES WITH ICD-9CM COOES 



DX GROUP 
NUMBER DX GROUP LABEL 

SYMPTOMS, SIGNS, ILL-DEFINED CONDITIONS 



ICD-9-CM CODES 



120 GENERAL SYMPTOMS 

120.01 somatic/segmental dysfunction 

120.02 dizziness and giddiness 

120.03 malaise and fatigue 

120.04 ottier general symptoms 



739 

780.4 

780.7 

347. 780, 780.5, 780.8. 780 9. 782, 783, 785.6, 790. 792-796, 799 
799.2, 799.3, 799.8, 799.9 



121 COMA/ SYNCOPE 

121.01 coma 

121.02 syncope (fainting) and collapse 



780.0. 850.3, 650.4 
780.2 



122 



FEVER 



780.6 



123 RESPIRATORY/OTHER CHEST SYMPTOMS 

123.01 dyspnea {labored breathing)/ottier respiratory abnomialities 

123.02 hemoptysis (cougtiing up blood) 

123.03 cough 

1 23.04 respiratory/other chest symptoms 



786.0 
7853 
786.2 

784, 784.1. 784.2. 784.4-784.9. 786. 786.1. 786.4. 786.6-786 9 



124 CARDIOVASCULAR SYMPTOMS 

124.01 chest pain 

124.02 other cardiovascular symptoms 



786.S 

785. 785.0-785 3. 785 9 



125 URINARY SYSTEM/ABDOMINAL-PELVIS SYMPTOMS 

125.01 retention of urine 

125.02 incontinence/urethral discharge 

125.03 other urinary system symptoms 

125.04 abdominal/pelvis symptoms 



788.2 

788.3. 788.7 

788. 788.0. 788.1. 788.4-788.6. 788.8. 788.9. 791 

789 



INJURY AND POISONING 



126 VERTEBRAL INJURY 

126.01 vertebral fracture without spinal cord injury 

126.02 vertebral fracture with spinal cord injury 



80S 
806 



127 FRACTURES OF SKULL/FACE/NASAL BONE 

127 01 fractures of skull/Tace 
127.02 fractures of nasal bone 



80(W02. 802.2-802.9. 803. 804 
802.0, 802.1 



128 



PELVIC FRACTURE 



808 



129 



FEMORAL FRACTURE 



820, 821 



130 



LOWER LIMB FRACTURES (E.G., LEG, ANKLE. FOOT) 



822-825, 827, 828 



13 

dcgVinafNappx-x\Tab-ti 1 Vtab 



TABLE B-1 

DXGROUP DIAGNOSTIC CATEGORIES WITH ICD-9^M CODES 



DX GROUP 
NUMBER 



DX GROUP LABEL 



131 FRACTURE/DISLOCATION 

131.01 shoulder dislocation 

131.02 dislocation of hip 

131.03 dislocation of knee, including cartilage/meniscus tear 

131.04 other dislocations 

1 31 .05 fracture of rib, closed 

131.06 hand/wrist/lower ami fracture 

131.07 other fractures 



1CD-9-CM CODES 

831 
835 
836 

830, 832-834, 837-839 

807.0 

813-817 

807, 807.1-807.6, 809-812, 818. 819, 826, 829 



132 INTERNAL AND/OR OPEN WOUND 

132.01 foreign txxiy in pharynx/larynx 

132.02 Injury to heart/lung/intrathoracio organs/blood vessels of thorax 

132.03 gastrointestinal/liver/kidney/spleen/peMs injury 

132.04 open wound of eye 

132.05 open wound/injury of lower arm 

132.06 open wound of other sites 

132.07 traumatic amputation of leg/hand/foot/toe 

132.08 coishing injury 

132.09 foreign tody in eye/ear/nose 



933-939 

860-862, 901 

863-869, 902 

870, 871 

881-883, 885, 886, 913-915, 959.3-959.5 

872-880. 884. 890-894. 900. 903. 904 

887, 895, 896, 897 

925-929 

930-932 



133 



SPRAINS 



840-848 



134 CONTUSIONS/ACCIDENTS/INJURY, SUPERFICIAL AND NOS 

134.01 concussion 

134.02 contusion/superficial injury 



850, 850.0-850.2, 850.5, 850.9 

910-912, 916-924. 959. 959.0-959.2. 959.6-959.9 



134.03 accidental falls 

134.04 attempted suicide/self-inflicted injury 

134.05 other accidents 



E88. E880-E888 
E95, E950-E959 
E80-E84, E800-E848, E89-E92, E890-E928, E96-E99, E960-E999 



135 



INTRACRANIAL (HEAD) INJURY 



851-854 



136 BURNS/NERVE, SPINAL CORD INJURES 

136.01 third degree burns 



940.3, 9404, 941,3-941.5, 942.3-942,5, 9433-943,5, 944,3-944 5, 9453- 
945.5, 946,3-946.5, 949.3. 949.5 



136.02 ottierbums 

136.03 nerve injury (including spinal cord Injury without spinal bone Injury) 

136.04 early complications of trauma 



940. 940.0-940.2. 940.9. 941. 941.0-941.2. 942. 942.0-942.2. 943. 943 0- 
943 2. 944, 944.0-944.2, 945, 9450-9452, 946, 946.0-946,2, 947-949, 
949.0-949.2 
950-957 

958 



137 POISONING/TOXIC EFFECTS 

137.01 accidental poisoning by prescription or over4he-counter medications/biological substances 960-979, E85, E850-E858 
including medication errors 

137.02 poisoning by specified nonmedioinal substances/injury by certain external causes 

137.03 poisoning by other nonmedicinal substances 

137.04 allergy, unspecified 

137.05 adverse effects of correctly prescribed and administered dmgs In therapeutic use 



980-988, 990-995, 995.0, 995.1, 995.4, 995.8, 995 89. E86, E860-E869 

969 

995.3 

995.2, E93, E94, E930-E949 



14 
dcg\fina(\appx-x\Tab-b1Viab 



TABLE B-1 

DXGROUP DIAGNOSTIC CATEGORIES WITH ICD-9-CM CODES 



DX GROUP 
NUMBER 



DX GROUP LABEL 



ICD-9^M CODES 



138 COMPLICATIONS OF MEDICAL PROCEDURES AND CARE 

138.01 malfunction of internal orthopedic device/graft 

138.02 infection/inflammation due to internal device/gran, transplant failure/rejection 

138.03 other complications of certain specified medical procedures 



996.4 

996.6, 996.8 

996, 996.0-996.3, 996.5, 996.7-996.9 



138.04 Other complications of medical and surgical procedures, neo (e.g.. post-operative infection) 997-999 

138.05 misadventure or abnonnal reaction/complication of patient during surgery on medical care E87, E870-E876, E878-E879 

FACTORS INFLUENCING HEALTH STATUS/CONTACT WITH HEALTH SERVICES (V-CODE) 



139 ORGAN REPLACEMENT/TFiANSPLANT/POST-SURGICAL STATES 

139.01 kidney, heart, heart valve (human/animal tissue), lung, lever transplant 

139.02 other organ transplant 

139.03 heart, heart valve replacement by artificial device 

139.04 joint replacement 

139.05 other organ replacement 

139.06 artificial opening status/attention 

139.07 postsurgical states, eye 

139.08 other postsurgical states, including dialysis status 

139.09 aspirator, respirator, other machine dependence 



V42.0, V42.1, V42.2, V42.6, V42.7 

V42, V42.3- V42.5, V42.8, V42.9 

V43.2, V43.3 

V43.6 

V43, V43.0, V43.4, V43.5, V43.7, V43.8 

V44, V55, 569.6 

V45.4 

V45. V45.0-V45.3, V45.5, V45.6. V45,8, V45.81, V45.89 

V46, V46.0, V46.1. V46.8, V46.9 



140 



REHABILITATION PROCEDURES 



V57 



141 



RADIATION THERAPY 



V58.0, V67.1 



142 



CHEMOTHERAPY 



V58.1,V67.2 



143 HISTORY OF DISEASE/AFTERCARE/SCREENING 

143.01 infectious disease contact/canier 

143.02 vaccination, medical exam, other preventive 

143.03 history of malignant neoplasm 

143.04 history of mental disorder/other disease 

143.05 history of drug allergy/other health hazard 

143.06 family history of disease 

1 43.07 problems of internal organs/external sites 

143.08 elective surgery 

143.09 prothesis/other device fitting, adjustment 

143.10 other orthopedic aftercare 

143.11 aftercare 

143.12 donor 

143.13 household/family/other psychosocial circumstances 

1 43. 1 4 care not delivered 

143.15 administrative/consultation 

143. 16 screening for malignant neoplasm 

143.17 screening/observation/special exams 



V01, V02 

V03-V07, V20, V21, V25, V26. V29, V70 

V10 

V11-V13 

V14, VI 5 

V16-V19 

V41, V47-V49 

V50, V51 

V52,V53 

V54 

V58, V58.2-V58.5, V58.8, V58.9, V66 

V59 

V60, \/61,V62 

V63,V64 

V65, V68 

V76 

V67, V67.0, V67.3-V67.6, V67.9, V71-V75, V77-V82 



15 
dcg\/inal\appx-x\TBb-b1Viab 



TABLE B-2 



1992 MEDICARE PROGRAM EXPENDITURES AND 1991 FREQUENCY OF ENROLLEES FOR PRINCIPAL INPATIENT DIAGNOSTIC GROUPS 
(UPPER CASE LABELS) AND HOSPITAL AND PHYSICIAN (ALL) DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXGROUP 



Label 



- ENTIRE 2.5% MODEL DEVELOPMENT SAMPLE 

-1 DIAG CODE NOT VALID 
-1 .0 diag code not valid 

NO INPATIENT CLAI MS IN DATA 
0.0 no claims in any data 

INFECTIOUS AND PARASITIC DISEASES 



Frequency* 

680,188 

6 
5,889 

554,125 
74,931 



Mean 
Expenditures" 

S3,783 

16,077 
6,753 

2,869 
1,334 



Standard 

Error 
of Mean 

$13 



12 
26 



Coemclent 

of Variation 

(X 100) 

273 



299 
430 



1 CENTRAL NERVOUS SYSTEM INFECTION (E.G.. MENINGITIS) 
1.01 central nervous system infection (e.g., meningitis) 

2 SEPTICEMIA/SHOCK 
2.01 septicemia/shock 

3 HIV/AIDS (INCLUDING PNEUMOCYTOSIS) 
3.01 HIV/AIDS (including pneumocytosis) 

4 OTHER INFECTIOUS AND PARASITIC DISEASES 

4.01 bacterial enteritis (intestinal infections) 

4.02 viral enteritis (intestinal infections) 

4.03 ottier intestinal infections 

4.04 tuberculosis 

4.05 strep throat/scarlet fever 

4.06 other bacterial infections 

4.07 bacterial infection in ottier diseases 

4.08 herpes zoster 

4.09 herpes simplex 

4.10 viral hepatitis 

4. 1 1 other viral infections 

4.12 late syphilis, symptomatic 

4.13 dermatophytosis (fungal skin Infections, eg,, athlete's foot) 

4.14 thrush 

4.15 mycoses (fungal diseases), miscellaneous 

4.16 other infections 



110 
1,821 

1,921 
6.722 

26 
4S0 

1,401 
1,103 
2,264 
2,224 
1.942 
1.342 
1,282 
9,753 
6,965 
1,860 
600 

15,117 
279 

48,799 
1,013 
3,732 
8,696 



8,322 
8,028 

12,888 
14.327 

25,697 
11,731 

9,230 
9,328 
6,031 
6,780 
7,630 
4,170 
6,453 

10,116 
4,703 
5,330 
7,762 
4,948 
7,152 
6,064 

10,011 
7,318 
6,271 



1,190 
379 



389 

9,715 
1,316 

486 
606 

291 
305 
401 
242 

378 
203 
147 
292 
646 

93 
852 

60 
722 
2S6 
162 



150 
202 

169 
223 

193 
238 

197 
216 
229 
212 
231 
212 
210 
198 
260 
236 
204 
232 
199 
217 
229 
214 
240 



LATE EFFECTS 



5 LATE EFFECTS 

5-01 infection late effects 

5.02 cerebrovascular disease late effects 

5.03 injury late effects 

MALIGNANT NEOPLASM 



222 
656 

9,109 
1,644 



10,315 
7.553 
8,790 
7.407 



1.092 
660 
170 
384 



158 
224 
185 
210 



6 f*10UTH/PHARYNX/LARYNX/OTHER RESPIRATORY CANCER 

6.01 cancer of mouth/tongue 

6.02 cancer of pharynx 
6 03 cancer of larynx 

604 other respiratory/intrathoracic cancer 

7 STOMACH/SMALL BOWELA-IVERyPANCREAS/ESOPHAGUS CANCER 

7.01 cancer of esophagus 

7.02 cancer of stomach 

7.03 cancer of small bowel 

7.04 cancer of liver 

7.05 cancer of pancreas 

7.06 other cancer of digestive organs/peritoneum 

8 COLON CANCER 
8.01 colon cancer 

9 RECTAL CANCER 
9.01 rectal cancer 

10 LUNG CANCER 

10.01 lung cancer 



244 
1,002 
612 
961 
437 

411 
386 
738 
638 
594 
580 
537 

1,231 
5,954 

473 
4,976 

778 
4,840 



14,449 
9.184 

12.411 
8.787 
8.397 

16.743 
15,691 
11.057 
12.094 
14.962 
12.401 
9.171 

9.198 
7,735 

9,950 
8,046 

15,080 
12,170 



1,651 
648 

1,091 
543 
752 

1.195 
1.574 
871 
932 
872 
989 
752 

434 

198 

807 
229 

707 
295 



178 
223 
218 
192 
187 

145 
197 
214 
195 
142 
192 
190 

166 
197 

176 
200 

131 
168 



dcg\iinal\appx-x\Tab-b2\nab 



TABLE B-2 

1992 MEDICARE PROGRAM EXPENDITURES AND 1991 FREQUENCY OF ENROLLEES FOR PRINCIPAL INPATIENT DIAGNOSTIC GROUPS 
(UPPER CASE LABELS) AND HOSPITAL AND PHYSICIAN (ALL) DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXGROUP 



Label 



MALIGNANT NEOPLASM (continued) 

11 BREAST CANCER 
11.01 breast cancer 

12 HODGKIKS DISEASE/LYMPHOMA/MYELOMA/LEUKEMIA 

12.01 lymptioma/Karposi's sarcoma/Hodgkin's Disease 

12.02 multiple myeloma 

12.03 lymphoid leukemia 

12.04 myeloid leukemia 

12.05 other leukemia 

13 CANCER OF UTERUS/CERVIX/FEMALE GENITAL ORGANS 

13.01 cancer of uterus 

13.02 cancer of cervix/female genital organs 

14 CANCER OF PLACENTA/OVARY/UTERINE ADNEXIA 
14.01 cancer of ovaries/placenta/uterine adnexia 

15 CANCER OF PROSTATE/TESTIS/MALE GENITAL ORGANS 

15.01 prostate cancer 

15.02 cancer of testis/male genital organs 

16 CANCER OF BLADDER/KIDNEY/URINARY ORGANS 
16.01 cancer of bladder/kidney/urinary organs 

17 NEOPLASM OF NERVOUS SYSTEM 

17.01 cancer of the eye 

17.02 cancer of the brain/nervous system/pituitary, pineal glands 

17.03 benign neoplasm brain/nervous system/pituitary, pineal glands 

18 OTHER CANCER 

18.01 cancer of bone and articular cartilage 

18.02 cancer of connective and other soft tissue 

18.03 melanoma 

18.04 skin cancer, except melanoma 

18.05 thyroid/endocrine cancer 

18.06 other/ill-defined site cancer 

19 SECONDARY CANCERS 

19 01 secondary cancer of lymph node 

19.02 secondary cancer of respiratory and digestive systems 

19.03 secondary cancer of other site 

19.04 disseminated cancer 







Standard 


Coefficient 




Mean 


Error 


of Variation 


Frequency* 


Expenditures" 


of Mean 


(X 100) 


1,392 


4,980 


260 


195 


12,555 


4,955 


101 


229 


398 


19.911 


1,416 


142 


2,867 


9,359 


322 


184 


962 


10,797 


551 


158 


1,390 


9,024 


448 


185 


416 


14.098 


1.414 


205 


9S1 


11.342 


668 


182 


389 


7,965 


801 


198 


1,730 


5,690 


311 


227 


1.337 


6,368 


407 


234 


157 


15,249 


1,490 


122 


1,018 


9,543 


534 


179 


1,835 


6,840 


3oe 


193 


13,344 


6,670 


118 


205 


342 


7,991 


1,085 


251 


880 


10,768 


54B 


151 


5.562 


7.731 


210 


203 


237 


9,675 


1,054 


168 


313 


5,555 


646 


206 


2,057 


9,917 


417 


191 


1,604 


6.842 


337 


197 


296 


10,792 


1,062 


169 


1,291 


10.990 


565 


185 


995 


9,158 


594 


204 


1,410 


5,572 


343 


231 


25,950 


4,785 


72 


241 


525 


7,610 


704 


212 


7,828 


9,300 


3M 


198 


964 


20137 


760 


117 


2,039 


11,547 


397 


155 


3,019 


15,719 


394 


138 


5.014 


12,848 


286 


158 


1,212 


10,948 


544 


173 



BENIGN NEOPLASM. CARCINOMA IN SITU 



20 BENIGN NEOPLASMS 

20.01 trenign neoplasm of digestive system 

20.02 benign neoplasm of respiratory system 

20.03 benign neoplasm of skin 

20.04 tienign neoplasm of breast/other breast disorders 

20.05 benign neoplasm of urinary 

20.06 benign neoplasm of eye 

20.07 other benign neoplasms 

21 CARCINOMA IN SITU/NEOPLASM OF UNCERTAIN BEHAVIOR 

21.01 carcinoma in situ of digestive organs 

21.02 carcinoma in situ of respiratory system 
2 1 . 03 carcinoma in situ of other sites 

21.04 neoplasm of uncertain tjehavior, specified sites 

21.05 neoplasm of uncertain behavior nec/nos 

21.06 unspecified neoplasm 



854 


5.431 


G05 


325 


17,866 


5,598 


102 


244 


1,154 


8,957 


S29 


201 


18,708 


4,107 


75 


249 


78,655 


3,312 


32 


271 


832 


7,729 


689 


250 


1,017 


3.437 


260 


241 


12,639 


5,269 


118 


254 


453 


8.159 


784 


207 


1.562 


9.413 


467 


196 


771 


11,449 


642 


156 


5.252 


6.697 


197 


213 


5.671 


7.747 


216 


210 


12.885 


5.101 


109 


242 


21.666 


7.043 


103 


216 



dcg\finanappx-x\Tab>t)2Viab 



TABLE B-2 

1992 MEDICARE PROGRAM EXPENDITURES AND 1991 FREQUENCY OF ENROLLEES FOR PRINCIPAL INPATIENT DIAGNOSTIC GROUPS 
(UPPER CASE LABELS) AND HOSPITAL AND PHYSICIAN (ALL) DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXGROUP 



Label 



ENDOCRINE. NUTRITIONAL. AND METABOLIC DISEASES 

22 DIABETES WITHOUT COMPLICATIONS 
22.01 diatjetes without complications 

23 DIABETES WITH ACUTE COMPLICATIONS 

23.01 diatKtes with acute complications 

24 DIABETES WITH CHRONIC COMPLICATIONS 
24 01 diabetes with renal manifestation 

24.02 diabetes with other specified complications 

24.03 diabetes with unspecified complications 

25 HYPOGLYCEMIA 

25.01 hypoglycemic coma 

25.02 other hypoglycemia 

26 DISORDERS OF FLUID/ELECTROLYTE/ACID BASE BALANCE 
26.01 disorders of fluid/electrolyte/acid-base balance 

27 OTHER ENDOCRINE/NUTRITIONAL/METABOLIC DISEASES 

27.01 goiter 

27.02 thyrotoxicosis 

27.03 thyroid disorders 

27.04 adrenal gland disorders 

27.05 ovarian dysfunction 

27.06 testicular dysfunction 

27.07 other endocrine disorders 

27.08 miscellaneous endocrine disorders 

27.09 protein-calorie malnutrition 

27. 1 vitamin/other nutritional deficiencies 

27.1 1 disorders of lipoid metabolism (high cholesterol) 

27. 1 2 disorders of plasma protein metabolism 

27.13 disorders of mineral metabolism 

27.14 cystic fibrosis, metabolism disorders, nec/nos 

27.15 other hyperalimentation 

27.16 otiesity/localized adiposity 

GASTROINTESTINAL DISORDERS 

28 PANCREATITIS/ OTHER PANCREATIC DISORDERS 
28 01 acute pancreatitis 

28.02 chronic pancreatitis/other pancreatic diseases 

29 END STAGE LIVER DISORDERS 

29.01 end stage liver disorders 

29.02 esophageal varices 

30 OTHER LIVER DISORDERS 

30.01 cirrhosis 

30.02 other liver disorders 

31 DISEASES OF ESOPHAGUS 
31 .01 disease of esophagus 

32 ULCERS 

32.01 ulcer without perforation 

32.02 ulcer with perforation 

33 GASTRITIS/OTHER GASTRIC DISORDERS 

33.01 pyloric/duodenal obstruction 

33.02 gastritis/other gastric disorder (stomach disorders) 

34 APPENDICITIS 
34.01 appendicitis 

35 ABDOMINAL HERNIA/ COMPLICATED 
35.01 abdominal hernia, complicated 







Standard 


Coefficient 




Mean 


Error 


of Variation 


Frequency* 


Expenditures** 


of Mean 


(X 100) 


373 


12.327 


1.279 


200 


86.686 


6.316 


48 


225 


279 


13,620 


1,291 


158 


2.817 


9,163 


337 


195 


2.015 


13.161 


462 


158 


1,223 


13.609 


645 


166 


8.944 


10583 


204 


182 


14.894 - 


9.266 


148 


195 


402 


12.824 


1,065 


167 


596 


12,193 


958 


192 


3,767 


8.451 


301 


219 


3.154 


11.651 


3S0 


169 


41.958 


9.094 


89 


199 


694 


9.967 


838 


221 


3.968 


4.701 


208 


279 


5.428 


4,758 


155 


240 


34.363 


4.676 


59 


233 


1.376 


9.618 


476 


184 


1.650 


3.314 


227 


278 


482 


5.672 


625 


242 


2.608 


4.603 


207 


230 


2.352 


7.001 


358 


248 


4.232 


14.210 


439 


201 


5.110 


5.995 


200 


239 


89.015 


3.646 


32 


259 


1.342 


9.365 


543 


212 


3.345 


7.498 


286 


220 


1.997 


5.491 


293 


238 


435 


5.894 


611 


216 


7.210 


5.456 


142 


222 


824 


10.023 


671 


192 


2.472 


8.774 


369 


209 


2.517 


9.760 


416 


214 


136 


20.886 


2.961 


165 


731 


15.783 


1.284 


220 


419 


15.269 


1,636 


219 


339 


13.812 


1.541 


205 


2,082 


11.305 


529 


213 


7,019 


7.723 


211 


228 


1.109 


8.588 


436 


169 


23.294 


6,274 


98 


239 


2,129 


7.966 


348 


202 


19.380 


6.479 


108 


232 


851 


8.389 


724 


252 


1,861 


10516 


456 


187 


634 


10.497 


892 


214 


78.354 


6.344 


50 


221 


335 


5.579 


801 


263 


881 


7,219 


565 


232 


467 


5,879 


520 


191 


1.667 


6.603 


357 


221 



dcg\final\appx-x\Ta b-b2Viab 



TABLE B-2 

1992 MEDICARE PROGRAM EXPENDITURES AND 1991 FREQUENCY OF ENROLLEES FOR PRINCIPAL INPATIENT DIAGNOSTIC GROUPS 
(UPPER CASE LABELS) AND HOSPITAL AND PHYSICIAN (ALL) DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXGROUP 



Label 



GASTROINTESTINAL DISORDERS (continued) 

36 ABDOMINAL HERNIA/ UNCOMPLICATED 
36.01 abdominal hemia/uncomplioated 

37 REGIONAL ENTERITIS 

37.01 regional enteritis (Crohn's disease) 

37.02 ulcerative colitis 

38 PERITONITIS/INTESTINAL OBSTRUCTION 

38.01 intestinal obstruction 

38.02 peritonitis 

38.03 other peritoneal disorders 

39 DIVERTICULA OF INTESTINE 
39.01 divercula of intestine 

40 ANAL/RECTAUGASTROINTESTINAL DISORDERS 

40.01 hemorrhoids 

40.02 anal/rectal disorders 

40.03 intestinal aticess/ulceration/perforation 
40 04 other Intestinal disorders 

41 GALLBLADDER DISORDERS 

41.01 cholelithiasis (gallstones) 

41 .02 biliary tract disease 

41.03 other gallbladder disorders 

42 GASTROINTESTINAL HEMORRHAGE 
42.01 gastrointestinal hemorrhage 

DISEASES OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE 

43 GOUT/ARTHROPATHY/DERANGEMENTS 

43.01 gout/crystal arthropathy 

43.02 other arthropathy/joint disorders, derangements 

44 CONNECTIVE TISSUE DISEASES 

44.01 systemic lupus erythematosus and other connective tissue disease 

44.02 rheumatoid arthritis and other inflammatory polyarthropathy 

44.03 inflammatory spondylopathies 

44.04 polymyalgia rheumatica 

45 ARTHR0PATHY/80NE INFECTION 

45.01 arthropathy with infection 

45.02 osteomyelitis 

46 OSTEOARTHRITIS 
4601 osteoarthrosis 

47 BACK PAIN 

47.01 back disorders (e.g., slipped disk, lumbago, sciatica, backache) 

48 DISORDERS OF SOFT TISSUES 
48.01 disorders of soft tissue 

49 OTHER BONE DISORDERS 

49.01 osteoporosis 

49.02 other bone disorders (e.g., curvature of spine, Pagefs disease) 

49.03 flat foot, acquired deformities of toe 

49.04 other acquired limb deformities 







Standard 


Coefficient 




Mean 


Error 


of Variation 


Frequency* 


Expenditures" 


of Mean 


(X 100) 


1,609 


6.426 


327 


204 


27,730 


5.664 


77 


227 


207 


10,863 


1,591 


211 


1.318 


8,058 


519 


234 


1.424 


6,953 


431 


234 


2,248 


9,824 


408 


197 


11,083 


9,762 


200 


216 


909 


12,575 


1,079 


259 


1,346 


8.105 


479 


217 


1,990 


7,357 


293 


177 


32,651 


5,351 


70 


236 


1,894 


9,065 


374 


180 


16,383 


4,608 


94 


262 


20,330 


5,528 


99 


256 


2,956 


8,428 


364 


247 


25,879 


6,487 


90 


224 


3,923 


5,769 


217 


236 


8,164 


6,652 


156 


212 


1,535 


9,707 


560 


226 


10,619 


6,728 


153 


234 


1,686 


10781 


516 


196 


22,399 


7,470 


122 


244 


555 


7,868 


531 


159 


11.996 


5,451 


113 


227 


99.251 


5,528 


40 


228 


583 


10,054 


624 


150 


4,900 


6,757 


240 


248 


13,589 


6,185 


114 


215 


1,926 


5,888 


292 


218 


3,313 


5,235 


194 


213 


434 


12,511 


966 


161 


1,164 


8,128 


533 


224 


3,340 


9,854 


319 


187 


3,751 


5,431 


166 


187 


105,463 


5,086 


36 


228 


2.841 


7,317 


243 


177 


90.991 


5,317 


40 


224 


667 


8,393 


679 


209 


97.065 


5,327 


40 


233 


1,520 


9,539 


423 


173 


16,184 


6,525 


106 


207 


18.957 


6,558 


100 


209 


13.798 


5.134 


100 


228 


3.484 


6.803 


226 


196 



dcg\finaAappx-]cMab-b2Viab 



TABLE B-2 

1992 MEDICARE PROGRAM EXPENDITURES AND 1991 FREQUENCY OF ENROLLEES FOR PRINCIPAL INPATIENT DIAGNOSTIC GROUPS 
(UPPER CASE LABELS) AND HOSPITAL AND PHYSICIAN (ALL) DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXGROUP 



Label 



DISEASES OF BLOOD AND BLOOD-FORMING ORGANS 

50 ANEMIA 

50.01 iron deficiency and other anemias 

51 OTHER BLOOD DISEASES 

51 .01 sickle cell and other hereditary hemolytic anemias 

51.02 acquired hemolytic anemia 

51.03 aplastic anemia 

51.04 hemophilia and other coagulation defects 

51.05 purpura/thromtiocytopathy/hemorrtiagio conditions 

51.06 white blood cell disorders 

51.07 immune disorders 

51.08 other blood disease 

MENTAL DISORDERS 

52 DEMENTIA 

52.01 senile/presenile psychoses 

52.02 other organic psychotic conditions 

52.03 cerebral degeneratioru'Alzheimer's disease 

52.04 senility without psychosis 

53 SUBSTANCE-RELATED PSYCHOSES 
53.01 alcoholic psychoses 

53 02 dnjg psychoses 

54 DELIRIUMTHALLUCINATIONS 

54.01 delirium/delusions/hallucinations 

54.02 hallucinations, symptomatic 

55 SCHIZOPHRENIC DISORDERS 
55.01 schizophrenic disorders 

56 MANIC AND DEPRESSIVE DISORDERS 
56.01 manic and depressive disorders 

57 PARANOIA AND OTHER PSYCHOSES 

57.01 paranoid states 

57.02 other nonorganic psychoses 

58 NEUROTIC DISORDERS 

58.01 neurotic disorders (e.g. anxiety, panic attack, phobias) 

59 SUBSTANCE ABUSE AND DEPENDENCE 
59.01 alcohol dependence 

59 02 drug dependence 

59.03 non-dependent abuse of dnjgs 

60 OTHER MENTAL DISORDERS 

60.01 personality disordere 

60.02 sexual deviations and disorders 

60.03 psychophysiologic disorders 

60.04 acute reaction to stress 

60.05 adjustment reaction 

60.06 nonpsychotio organic brain syndrome 

60.07 depression, not elsewhere classified 

60.08 behavior disorder 

60.09 developmental behavioral disorders 

60.10 mental retardation 

60. 1 1 other mental disorders 







Standard 


Coefficient 




Mean 


Error 


of Variation 


Frequency* 


Expenditures" 


of Mean 


(X 100) 


794 


12,148 


eei 


153 


59,047 


7,128 


63 


215 


642 


16,494 


1,225 


188 


8S0 


7,973 


685 


251 


464 


11,101 


955 


185 


1.480 


14,799 


657 


171 


5,197 


8,104 


250 


223 


3,071 


9,851 


398 


223 


3,958 


9,972 


334 


211 


715 


8,729 


763 


234 


5,736 


7,616 


198 


197 


1,238 


8,760 


413 


166 


14,494 


7,293 


120 


198 


2,515 


8,124 


332 


205 


12,191 


7,526 


136 


200 


1,269 


5,755 


313 


193 


306 


11,246 


1,149 


179 


1,062 


9,516 


546 


187 


842 


9,984 


619 


180 


380 


9,184 


640 


136 


3,755 


9,784 


294 


184 


605 


7,848 


501 


157 


1,654 


9,216 


320 


141 


8,113 


5,991 


137 


207 


2,399 


11,218 


3BS 


159 


11,916 


7,840 


144 


200 


590 


9,178 


663 


173 


719 


7,456 


482 


173 


11.695 


7,763 


138 


193 


406 


9.306 


690 


149 


25,304 


5,943 


78 


210 


887 


9,622 


548 


170 


3,115 


8,458 


310 


205 


848 


9,945 


528 


155 


4,129 


7,657 


231 


194 


802 


10,320 


508 


164 


1,896 


8,283 


dSB 


187 


1,361 


4,598 


279 


224 


946 


6,054 


406 


208 


1,399 


5,774 


291 


188 


3.729 


7,612 


270 


217 


7,682 


7,475 


175 


205 


11,894 


7,005 


126 


196 


680 


5,370 


569 


276 


835 


6,686 


493 


213 


3,531 


3,205 


173 


320 


1.857 


6,334 


290 


197 



dcg\finelNappx-x\Tab-b2Vuib 



TABLE B-2 

1992 MEDICARE PROGRAM EXPENDITURES AND 1991 FREQUENCY OF ENROLLEES FOR PRINCIPAL INPATIENT DIAGNOSTIC GROUPS 
(UPPER CASE LABELS) AND HOSPITAL AND PHYSICIAN (ALL) DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXGROUP 



Labtl 



NEUROLOGICAL DISORDERS 

61 HEADACHES 

61.01 headaches, Including migraine 

62 DEGENERATIVE NEUROLOGIC DISORDERS 

62.01 Parkinson's disease 

62.02 Huntington's Disease, other abnormal movement disorders 

62.03 anterior horn cell disease 

62.04 other spinal cord disease 

62.05 autonomic nerve disorder 

62.06 Tay-Sachs, other hereditary and degenerative central nervous system diseases 



63 OTHER NEUROLOGIC DISORDERS 

63.01 multiple sclerosis, other central nen/ous system dymelinatlon 

63.02 infantile cerebral palsy 

63.03 quadriplegia 

63.04 paraplegia 

63.05 Cauda equina syndrome 

63.06 other paralytic disorders 

63.07 nervous/musculoskeletal system symptoms 

63.08 other central nervous system disorders 

64 EPILEPSY AND OTHER SEIZURE DISORDERS 
64.01 epilepsy and other seizure disorders 

65 MONONEUROPATHY 

65.01 trigeminal nerve disorder 

65.02 facial nerve disorders 

65.03 root/plexus disorders 

65.04 root/plexus lesions 

65.05 other cranial nerve disorders 

65 06 neuropathy of upper limb (e.g., carpal tunnel syndrome) 

65.07 neuropathy of leg 

66 POLYNEUROPATHY 

66.01 peripheral neuropathy 

66.02 inflammatory/toxic neuropathy 

66.03 myoneural disorders/myasthenia gravis 

66.04 muscular dystrophies 

66.05 other neuropathy 

67 CEREBRAL CYSTS, COMPRESSION, EDEMA, ANOXIC DAMAGE, 
OTHER BRAIN CONDITIONS 

67.01 cerebral cysts, compression, edema, anoxic damage, other brain conditions 

CIRCULATORY DISORDERS 







Standard 


Coefficient 




Mean 


Error 


of Variation 


requency* 


Expenditures" 


of Mean 


(X 100) 


179 


8,110 


883 


146 


24.655 


5,689 


84 


231 


418 


10.595 


845 


163 


8.048 


7,012 


151 


193 


3.112 


6,076 


236 


216 


395 


9,162 


1.295 


281 


1.096 


8,258 


538 


216 


1,305 


9,392 


470 


181 


647 


8,555 


613 


182 


479 


11,376 


892 


172 


1,584 


6,785 


335 


197 


958 


4,516 


355 


243 


648 


11,953 


8SS 


183 


750 


12.351 


812 


180 


3,217 


9,550 


306 


182 


1.179 


9,894 


493 


171 


8.377 


7,710 


164 


195 


1.208 


8.845 


455 


179 


1,196 


10,031 


501 


173 


14,186 


7,010 


133 


226 


202 


10,056 


1,264 


179 


1,299 


5,026 


251 


180 


1,408 


5956 


351 


221 


587 


5,503 


432 


190 


648 


5,474 


434 


202 


339 


6,433 


648 


186 


6.464 


5,336 


ISO 


226 


6,283 


6,218 


166 


212 


146 


16,282 


2,199 


163 


4,767 


7,716 


218 


195 


2,659 


10,037 


340 


175 


559 


7,818 


624 


189 


745 


10,277 


795 


211 


883 


6.188 


442 


212 


123 


11,554 


1,469 


141 


4,570 


10,376 


352 


229 



68 VALVULAR AND RHEUMATIC HEART DISEASE 

68.01 rheumatic fever/heart disease 

68.02 mitral or aortic valve/endocardia disease 

68.03 mitral/aortic valve disorders 

69 HYPERTENSION. UNCOMPLICATED 

69.01 essential hypertension 

69.02 hypertensive heart disease 

70 HYPERTENSION. COMPLICATED 

70.01 malignant hypertension 

70.02 malignant hypertensive heart disease 

70.03 hypertensive heart and renal disease 

70.04 secondary hypertension 

70.05 hypertension encephalopathy 

71 MYOCARDIAL INFARCTION 

71.01 myocardial infarction 

71.02 old myocardial infarction 

7 1 .03 other chronic ischemic heart disease 



762 


7,471 


465 


172 


3.439 


9,123 


336 


216 


27,114 


7,650 


102 


219 


5,545 


8,819 


244 


206 


1,173 


11,102 


517 


159 


228.968 


4,592 


24 


250 


24,903 


6,159 


91 


232 


668 


10.591 


737 


180 


17.840 


5.231 


96 


244 


2.676 


6,121 


290 


245 


3.049 


10,309 


433 


232 


565 


7,682 


922 


285 


868 


7,539 


440 


184 


3.883 


7,538 


252 


208 


12,823 


8,840 


170 


218 


10.199 


7,827 


161 


207 


115,919 


6.482 


42 


220 



dcgVtnal\appx-x\Tal>b2Viab 



TABLE B-2 

1992 MEDICARE PROGRAM EXPENDITURES AND 1991 FREQUENCY OF ENROLLEES FOR PRINCIPAL INPATIENT DIAGNOSTIC GROUPS 
(UPPER CASE LABELS) AND HOSPITAL AND PHYSICIAN (ALL) DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXGROUP 



Label 



CIRCULATORY DISORDERS (continued) 



Frequency* 



Mean 
Expenditures*' 



Standard 

Error 
of Mean 



CoefTiclent 

of Variation 

(X 100) 



72 
72.01 



ACUTE MYOCARDIAL INFARCTION (HEART ATTACK) 
acute myocardial Infarction (heart attack) 



4,501 
6.367 



9.014 
9.680 



286 
255 



213 
210 



73 
73.01 



OTHER ACUTE ISCHEMIA 
other acute ischemia 



6,895 
19,598 



9,277 
S.SS2 



210 
125 



168 
204 



74 
74.01 



ANGINA PECTORIS 
angina pectoris 



2,121 
42,156 



8.932 
7,103 



307 
74 



158 
213 



75 PULMONARY HEART DISEASE 

75.01 pulmonary embolism (blood clot) 

75.02 other pulmonary heart disease 



595 
2,696 
5,209 



10,744 
10,459 
9,890 



769 
451 
290 



175 
224 
212 



76 RHYTHM AND CONDUCTION DISORDERS 

76.01 conduction disorders/cardiac dysrhythmias 

76.02 premature heart beats 



2,869 
61,115 
12,935 



7,875 
6,795 
6,623 



277 

62 

134 



188 
226 
231 



77 
77.01 



ATRIAL ARRYTHMIA 
atrial arrhythmia 



3,013 
35,037 



8,033 
7,608 



2SS 
86 



177 
213 



78 
78.01 



VENTRICULAR TACHYCARDIA 
ventric tachycardia 



448 
4,097 



11,652 
9.761 



1.050 
326 



191 
214 



79 
79.01 



HEART ARREST/ SHOCK 
heart arrest/shock 



77 

2,537 



11,178 
10.433 



1.883 
472 



148 
228 



80 
80.01 



HEART FAILURE 
heart failure 



7.600 
58.713 



13.902 
9.073 



257 
76 



161 
2(S 



81 OTHER CARDIAC DISEASE 

81.01 pericarditis, post-MI 

81.02 acute endo/myocardilis 

81.03 cardiomyopathy/myocarditis 

81.04 cardiomegaly (enlarged heart) 

81.05 other heart disease 



537 

2,259 

620 

9,072 

19.595 

13,961 



10,224 
8,413 
9,646 
9,468 
8,797 
7,568 



782 
356 
906 
194 
127 
140 



177 
201 
234 

195 

202 
218 



82 
82.01 



CEREBRAL HEMORRHAGE 
cerebral hemorrhage 



587 

3,057 



8.561 
8.958 



603 
357 



171 
220 



83 
83.01 



PRECEREBRAL ARTERIAL OCCLUSION 
precerebral arterial occlusion 



1.423 
14.926 



7,639 
7,282 



392 
119 



194 
199 



84 CEREBROVASCULAR DISEASE 

84.01 cerebrovascular accident (stroke) 

84. 02 hemiplegia (paralysis of one side of body) 

84.03 aphasia (loss of language skills/comprehension) 



5,517 

34,267 

5,844 

1,734 



10.464 
8.153 
9.973 
9.541 



264 

S3 

250 

489 



188 
211 
191 
213 



65 
85.01 



TRANSIENT CEREBRAL ISCHEMIA 
transient cerebral ischemia 



2.462 
17.453 



7.992 
7,186 



299 

111 



186 

204 



86 ATHEROSCLEROSIS 

86.01 atherosclerosis of major vessel 

86.02 atherosclerosis/general, ascvd 



749 
16,053 
39,122 



11,115 
8.091 
6,683 



612 

137 

75 



151 
215 
222 



87 
87.01 
87.02 



ANEURYSM 
aortic aneurysm 
other aneurysm 



820 
5,945 
1.695 



7,745 
8.492 
8.770 



6S0 
253 
500 



255 
229 
234 



88 
88.01 



ARTERIAL EMBOLISM AND THROMBOSIS 
arterial embolism and thrombosis (blood clots) 



859 

5.550 



11.974 
10.285 



638 
^0 



156 

203 



dcgVinaAappx-x\Tab-t>2Viab 



TABLE B-2 

1992 MEDICARE PROGRAM EXPENDITURES AND 1991 FREQUENCY OF ENROaEES FOR PRINCIPAL INPATIENT DIAGNOSTIC GROUPS 
(UPPER CASE LABELS) AND HOSPITAL AND PHYSICIAN (ALL) DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXGROUP 



LaM 



CIRCULATORY DISORDERS (continued) 

89 PERIPHERAL VASCULAR DISEASE 

89.01 specified peripheral vascular disease 

89.02 Raynaud's syndrome 

89.03 peripheral vascular disease 

89.04 other arterial disease 

89.05 disease of capillaries 

89.06 vascular insufficiency of intestines 

89.07 gangrene 

90 THROMBOPHLEBITIS 

90.01 phlebitis and thrombophlebitis 

90.02 noninfectious lymphatic disorders 
90 03 hemorrhage nos 

90.04 compression of vein 

91 HYPOTENSION (LOW BLOOD PRESSURE) 
91.01 hypotension (low blood pressure) 

92 OTHER CIRCULATORY DISEASE 

92.01 superficial phlebitis-leg 

92.02 varicose veins 

92.03 other circulatory disease/poslphlebitic syndrome 

92.04 other specified circulatory disorders 

DISORDERS OF THE EYE AND ADNEXA 

93 DISORDERS OF THE EYE AND ADNEXA 

93.01 diabetic retinopathy 

93.02 proliferative diabetic retinopathy 

93.03 endophthalmitis (eye inflammation) 

93.04 retinal disorders 

93.05 glaucoma 

93.06 cataract/lens replacement 

93.07 disorders of refraction and accommodation (e.g., far-, near-sightedness, astigmatism) 

93.08 vitreous hemorrhage 

93.09 other eye disorders 

DISORDERS OF THE EAR AND MASTOID PROCESS 

94 EAR DISORDERS 

94.01 impacted earwax 

94.02 otitis media (middle ear infection) 

94.03 vertiginous syndromes 

94.04 hearing loss 

94. 05 other ear disorders 

DISEASES OF THE RESPIRATORY SYSTEM 

95 NOSE/ THROAT DISEASES 

95.01 acute nose/throat infection 

95.02 nasal polyps/allergic rhinitis 

95.03 chronic sinusitis 

95.04 larynx/vocal cord diseases 

95.05 paralysis of vocal cords/larynx 

95.06 disorders of teeth, gum, and jaw (eg., periodontitis, gingivitis) 

95.07 other diseases of upper respiratory system 

95.08 salivary gland diseases 

95.09 oral soft tissue/tongue/jaw disorders 

96 EMPHYSEMA/CHRONIC BRONCHITIS 
96.01 emphysema/chronic bronchitis 

97 OTHER BRONCHITIS 
97.01 other bronchitis 







Standard 


Coefficient 




Mean 


Error 


of Variation 


Frequency* 


Expenditures" 


of Mean 


(X 100) 


867 


12,235 


817 


197 


2,725 


8.880 


349 


205 


855 


5.S24 


se 


TSB 


25,398 


8,023 


101 


200 


6,261 


8.574 


236 


217 


851 


4.772 


389 


238 


1,148 


11.253 


899 


271 


2,374 


13,632 


S29 


189 


1,426 


9.395 


457 


184 


11,704 


7.772 


154 


214 


1.329 


7.427 


3S2 


173 


984 


8.445 


492 


183 


703 


8.572 


665 


206 


527 


9.040 


797 


202 


6,203 


8.469 


218 


203 


461 


10,167 


729 


154 


1,674 


6,757 


365 


221 


8,613 


6,535 


159 


226 


5,475 


8,346 


220 


195 


6,652 


7,479 


182 


199 


1,092 


6,360 


375 


195 


9,228 


7,915 


156 


189 


1,669 


9,250 


393 


173 


565 


6,320 


682 


256 


50,148 


4,827 


50 


233 


52.719 


4,324 


46 


246 


169,161 


4,312 


26 


248 


25,026 


3,609 


62 


270 


1,390 


7,364 


38S 


195 


116,990 


4,534 


33 


248 


595 


5,832 


467 


195 


26,548 


4,433 


66 


241 


16,021 


4,155 


80 


243 


11,137 


4,558 


ICO 


232 


16.499 


4,697 


85 


232 


19,259 


4,612 


81 


244 


542 


8,638 


650 


175 


78,683 


4,439 


39 


248 


21.485 


3,960 


63 


233 


19.925 


4,520 


81 


252 


2.025 


6,561 


338 


232 


467 


12,032 


1,143 


205 


5.396 


5,112 


152 


219 


10.983 


5,072 


121 


249 


1.697 


5,395 


281 


215 


4.338 


5,936 


243 


271 


2.464 


15,954 


482 


150 


70.020 


7,345 


60 


216 


2.639 


11.284 


378 


172 


74.565 


5.465 


46 


227 



8 

dcgVina^appx•x\Tat>-b2^nab 



TABLE B-2 

1992 MEDICARE PRCX3RAM EXPENDITURES AND 1991 FREQUENCY OF ENROLLEES FOR PRINCIPAL INPATIENT DIAGNOSTIC GROUPS 
(UPPER CASE LABELS) AND HOSPITAL AND PHYSICIAN (ALL) DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DX6R0UP 



Label 



DISEASES OF THE RESPIRATORY SYSTEM (continued) 



Frequency* 



Mean 
Expenditures" 



Standard 

Error 
of Mean 



Coefficient 

of Variation 

(X 100) 



98 VIRAL PNEUMONIA/INFLUENZA 

98.01 viral pneumonia 

98.02 innuenza 



350 

2.126 

10,833 



8,673 
8,647 
5,434 



795 
388 

138 



172 
207 
264 



99 GRAM-NEGATIVE/STAPHYLOCOCCUS PNEUMONIA 
99.01 gram-negative/staph pneumonia 



1,324 
2,433 



14,070 
14,837 



822 
581 



161 
193 



100 
100.01 



BACTERIAL PNEUMONIA 

pneumococcal and other specific bacterial pneumonia 



100.02 ottier pneumonia 



7,162 

3,175 

34,453" 



10,251 
10,384 
8,861 



225 
389 
108 



185 
211 
226 



101 
101.01 



ASTHMA 
asttima 



1,621 
20.952 



12.261 
6,887 



484 
104 



159 
219 



1 02 LUNG DISEASES DUE TO EXTERNAL AGENTS 

102.01 bronchiectasis, lung diseases due to specified external agent 

102.02 aspiration pneumonia 

102.03 respiratory conditions due to other external agents/postinflammatory fibrosis 



807 
2,836 
1,863 
6.206 



15,812 
7.252 

16.157 
7,923 



1,094 
292 
859 
235 



197 
215 
229 
233 



103 PLEURISY/PNEUMOTHORAX 
103.01 pleurisy/pneumothorax 



437 

13,535 



11,491 
10,550 



965 
192 



176 
212 



104 OTHER LUNG DISEASE 

104.01 empyema/abscess of lung 

104.02 pulmonary congestion/hypostasis 
104 03 acute lung edema nos 

1 04 04 post trauma/surgery pulmonary insufficiency 

104.05 other lung disease 



497 

783 

9,741 

2,126 

1,125 

23,837 



14,257 
12,300 

9,529 
15,453 
14,905 

8,720 



1.227 

1,109 

203 

713 

1,358 

133 



192 
252 
210 
213 
305 
236 



105 RESPIRATORY FAILURE/ARREST 

105.01 respiratory failure 

105.02 respiratory arest 



1,091 

16,794 

2,333 



17.276 
11.238 
19,696 



811 

203 

1,043 



155 
235 
256 



DISEASES OF THE GENITOURINARY SYSTEM 



106 RENAL FAILURE 

106.01 nephritis, dialysis encounter 

106.02 acute renal failure 

106.03 chronic renal failure 

106.04 renal failure, unspecified 

106.05 impaired renal function 



392 
2.200 
2.111 
3.819 
3.876 
1,130 



15,479 
11,310 
15,975 
12,960 
11,912 
9.045 



1,200 
518 
867 
458 
446 
540 



153 
215 
249 
218 
233 
201 



107 
107.01 



KIDNEY INFECTION 
kidney infection 



633 
4,023 



9,735 
7,432 



682 
234 



176 
199 



108 
108 01 



RENAL/URETERAL/BLADDER CALCULUS 
renal/ureteral/bladder calculus (e.g., kidney stones) 



938 
7,094 



5,194 
6,247 



332 

167 



196 
226 



109 OTHER REf^L/URETERAL DISEASES 

109.01 urethral Stricture 

109.02 hydronephrosis/olher renal/urethral disorders 



350 

5,869 

13,346 



10,320 
6.157 
8.689 



931 
162 
159 



169 
202 
211 



110 
110.01 



OTHER URINARY TRACT INFECTIONS 
cystitis, other urinary tract infections 



3.002 
81.604 



12,456 
6,251 



366 
48 



161 
221 



111 
111.01 



OTHER URINARY DISORDERS 
other urinary disorders 



618 
27.040 



9.470 
6,588 



694 
88 



182 
220 



112 PROSTATEH-ESTICULAR/PENILE DISORDERS 

112.01 hyperplasia of prostate 

112.02 other prostatic disorders 

1 12.03 penis/testis/male genital organs disorders 



3,751 
41,057 
14,543 

8,048 



5,248 
4,941 
4,874 
5,395 



221 
59 
89 

156 



258 
243 
221 
260 



9 

dcg\finarappx-x\Tab~b2Viab 



TABLE B-2 

1992 MEDICARE PROGRAM EXPENDITURES AND 1991 FREQUENCY OF ENROLLEES FOR PRINCIPAL INPATIENT DIAGNOSTIC GROUPS 
(UPPER CASE LABELS) AND HOSPITAL AND PHYSICIAN (ALL) DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DX6ROUP 



Label 



DISEASES OF THE GENITOURINARY SYSTEM (continued) 

113 DISEASES OF FEMALE GENITAL ORGANS 

113.01 diseases of female pelvic organs 

1 13.02 vaginal and cervical diseases 

1 1 3 03 other diseases of female genital organs 

1 13.04 female stress incontinence 

113.05 menopausal and postmenopausal disorders 

114 GENITAL PROLAPSE 
114.01 genital prolapse 

PREGNANCY-RELATED CONDITIONS 

1 15 PREGNANCY/PERINATAL CONDITIONS 

115.01 pregnancy/birth complications, mottier/ctiild 

115.02 pregnancy with abortive outcome 

115.03 normal pregnancy/delivery 

DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE 

116 DERMATOLOGICAL DISORDERS 

1 16.01 cellulitis/abscess/other local skin infection 

116.02 bullous dermatoses 

117 CHRONIC ULCER OF SKIN 
1 17.01 chronic ulcer of skin 

1 1 8 OTHER DEMATOLOGICAL DISORDERS 

118.01 dermatitis due to internal agent 

1 18.02 psoriasis and similar disorders 

118.03 other dermatosis 

1 1 8 04 diseases of nail 

118.05 other dermatological disorders 

CONGENITAL ANOMALIES 

1 19 CONGENITAL ANOMALIES 

1 19.01 spina bifida, other congenital anomalies of nervous system 

1 19.02 congenital anomalies of eye 

1 19.03 congenital anomalies of cardiac/circulatory systems 

1 19.04 congenital anomalies of musculoskeletaUlimb 

119.05 congenital anomalies of skin 

119 06 chromosomal anomalies 

1 19.07 other congenital anomalies 

SYMPTOMS. SIGNS, ILL-DEFINED CONDITIONS 

120 GENERAL SYMPTOMS 
120.01 somatic/segmental dysfunction 

120 02 dizziness and giddiness 
120 03 malaise and fatigue 
120.04 other general symptoms 

121 COMA/ SYNCOPE 

121.01 coma 

121.02 syncope (fainting) and collapse 

122 FEVER 
122.01 fever 

123 RESPIRATORY/OTHER CHEST SYMPTOMS 

123.01 dyspnea (labored breathing)/other resp abnormalities 

123.02 hemoptysis (coughing up blood) 

123.03 cough 

123 04 respiratory/other chest symptoms 







Standard 


Coefficient 




Mean 


Error 


of Variation 


Frequency" 


Expenditures" 


of Mean 


(X 100) 


709 


5.181 


369 


190 


5,244 


5,342 


164 


222 


16,923 


3.884 


74 


248 


9,692 


5.182 


112 


213 


3,495 


5,024 


162 


190 


26,913 


3.213 


53 


271 


1,117 


3,033 


214 


236 


7.185 


3,901 


102 


222 


129 


3,671 


496 


154 


4,143 


6,791 


249 


237 


214 


5,880 


686 


171 


417 


4,882 


707 


296 


2.110 


10,823 


403 


171 


40.048 


6,846 


75 


218 


645 


6,761 


554 


208 


869 


16.123 


731 


134 


16,985 


9.668 


146 


196 


214 


8.351 


1,187 


208 


1,398 


7,099 


470 


247 


4,550 


4,949 


185 


253 


43,223 


3,980 


47 


245 


38.168 


6,284 


68 


212 


86.073 


4,588 


39 


250 


122 


9.527 


1.737 


201 


1.016 


9,565 


704 


235 


2.208 


4,474 


241 


253 


7.535 


7,933 


213 


233 


5499 


6,221 


171 


204 


2.807 


4,580 


193 


223 


706 


2,951 


371 


334 


6,153 


6,893 


201 


228 


855 


9,313 


557 


175 


11,597 


4,066 


86 


229 


32,061 


5,489 


66 


216 


33,402 


6.055 


74 


223 


115,779 


6.037 


42 


235 


2.183 


7.773 


315 


189 


2,371 


10.430 


438 


204 


18.392 


7.229 


106 


203 


342 


12.400 


1,232 


184 


11,709 


9,467 


208 


237 


399 


9.781 


937 


191 


49.223 


8.430 


83 


218 


2,255 


9.446 


426 


214 


24,574 


5.869 


86 


228 


27,303 


7.585 


101 


220 



10 
dcgVinarappx-x\Tab-b2Vwb 



TABLE B-3 

REGRESSION OF 1992 MEDICARE PROGRAM EXPENDITURES ON 1991 
HOSPITAL AND PHYSICIAN (ALL) DIAGNOSIS DIAGNOSTIC GROUPS 
(R^= 10.46%) 



ADDXG 



LABEL 



106.0 


nephritis 


106.1 


acute renal failure 


106.2 


chronic renal failure 


106.3 


renal failure nos 


106.4 


impaired renal function 


107.0 


kidney infection 


108.0 


renal/ureteral calculus 


109.0 


urethral stricture 


109.1 


nydronephrosis/other renal/ure 


110.0 


other urinary disorders/cystit 


111.0 


other urinary disorders 


112.0 


hyperplasia of prostate 


112.1 


other prostatic disorders 


112.2 


penis/testis/male gen disorder 


113.0 


diseases of female pelvic orga 


113.1 


vaginal and cervical diseases 


113.2 


other diseases of female genit 


113.3 


female stress incontinence 


113.4 


menopausal disorders 


114.0 


genital prolapse 


115.0 


pregnancy/birth complications 


115.1 


abortion 


115.2 


normal pregnancy/delivery 


116.0 


dermatological disorders 


116.1 


bullous dermatoses 


117.0 


chronic ulcer of skin 


118.0 


dermatitis due to internal age 


118.1 


psoriasis/like disorders 


118.2 


other dermatosis 


118.3 


diseases of nail 


118.4 


other dermatological disorders 


119.0 


congenital anomalies of nervou 


119.1 


"-ongenital anomalies of eye 


119.2 


congenital anomalies of cardia 


119.3 


congenital anomalies of muscul 


119.4 


congenital anomalies of skin 


119.5 


chromosomal anomalies 


119.6 


other congenital anomalies 


120.0 


somatic dysfunction 


120.1 


dizziness and giddiness 


120.2 


malaise and fatigue 


120.3 


other general symptom 


121.0 


coma 


121.1 


syncope and collapse 


122.0 


pyrexia 


123.0 


dyspnea/other resp abnormaliti 


123.1 


hemoptysis 


123.2 


cough 


123.3 


respiratory/other chest sympto 


124.0 


chest pain 





T FOR HO: 




STD ERROR 


ESTIMATE 


PARAMETER=0 
6.87 


PR > ITI 


OF ESTIMATE 


1,555 


0.0001 


226 


1,910 


7.72 


0.0001 


247 


2,557 


14.06 


0.0001 


182 


1,281 


7.14 


0.0001 


179 


496 


1.63 


0.1032 


304 


-439 


-2.70 


0.0069 


163 


73 


0.59 


0.5536 


123 


229 


1.71 


0.0864 


134 


440 


4.65 


0.0001 


95 


217 


5.23 


0.0001 


42 


278 


4.10 


0.0001 


68 


-108 


-1.85 


0.0647 


58 


-175 


-1.96 


0.0502 


89 


98 


0.86 


0.3924 


115 


49 


0.34 


0.7312 


144 


-295 


-3.69 


0.0002 


80 


152 


1,43 


0.1531 


106 


115 


0.66 


0.5087 


174 


-184 


-2.82 


0.0048 


65 


41 


0.34 


0.7360 


121 


585 


3.72 


0.0002 


157 


224 


0.33 


0.7431 


682 


-444 


-0.90 


0.3664 


491 


651 


11.83 


0.0001 


55 


820 


2.06 


0.0396 


399 


1,862 


21.83 


0.0001 


85 


211 


0.78 


0.4354 


270 


389 


2.64 


0.0082 


147 


-29 


-0.56 


0.5781 


53 


264 


4.61 


0.0001 


57 


-92 


-2.39 


0.0167 


38 


1,725 


5.38 


0.0001 


321 


17 


0.08 


0.9346 


212 


634 


5.35 


0.0001 


118 


383 


2.81 


0.0049 


136 


-322 


-1.70 


0.0882 


189 


-833 


-2.21 


0.0270 


377 


53 


0.40 


0,6860 


130 


-141 


-1.48 


0.1384 


95 


26 


0.43 


0.6663 


60 


75 


1.29 


0.1974 


58 


188 


5.43 


0.0001 


35 


981 


4.55 


0.0001 


216 


227 


2.88 


0.0040 


79 


418 


4.19 


0.0001 


100 


aT3 


16.03 


0.0001 


52 


1,156 


5.29 


0.0001 


219 


-52 


-0.78 


0.4362 


67 


404 


6.18 


0.0001 


65 


290 


7.68 


0.0001 


38 



clcg\final\appx-x\Tat>-b3\nab 



TABLE B-3 

REGRESSION OF 1992 MEDICARE PROGRAM EXPENDITURES ON 1991 
HOSPITAL AND PHYSICIAN (ALL) DIAGNOSIS DIAGNOSTIC GROUPS 
(R^= 10.46%) 









T FOR HO: 




STD ERROR 


ADDXG 


LABEL 


ESTIMATE 
95 


PARAMETER=0 

1.43 


PR > ITI 


OF ESTIMATE 


124.1 


other cardiovascular symptoms 


0.1536 


67 


125.0 


retention of urine 


60 


0.52 


0.6049 


116 


125.1 


incontinence/urethral discharg 


463 


3.79 


0.0001 


122 


125.2 


other urinary system symptoms 


-53 


-0.72 


0.4687 


73 


125.3 


abdominal/pelvis symptoms 


374 


8.66 


0.0001 


43 


126.0 


vertebral fracture w/o spinal 


461 


3.14 


0.0017 


147 


126.1 


vertebral fracture with spinal 


118 


0.28 


0.7767 


415 


127.0 


fractures of skull/face 


130 


0.48 


0.6299 


269 


127.1 


fractures of nasal bone 


-435 


-1.22 


0.2233 


357 


128.0 


pelvic fracture 


604 


2.72 


0.0066 


222 


129.0 


femoral fracture 


217 


2.00 


0.0454 


109 


130.0 


fractures of lov^er limb 


245 


2.20 


0.0281 


111 


131.0 


shoulder dislocation 


402 


1.18 


0.2368 


340 


131.1 


dislocation of hip 


641 


1.26 


0.2065 


507 


131.2 


dislocation of knee 


■'23 


3.69 


0.0002 


196 


131.3 


other dislocations 


-79 


-1.00 


0.3191 


80 


131.4 


fracture of rib, closed 


236 


1.55 


0.1202 


152 


131.5 


hand/wrist/lower arm fracture 


31 


0.27 


0.7841 


114 


131.6 


other fractures 


186 


1.73 


0.0836 


108 


132.0 


foreign body in pharnyx/larnyx 


-125 


-0.54 


0.5859 


229 


132.1 


heart/lung/blood vessels injur 


-1,058 


-3.12 


0.0018 


340 


132.2 


gi/liver/kidney/spleen/pelvis 


630 


2.05 


0.0404 


307 


132.3 


open v^ound of eye 


186 


0.53 


0.5991 


354 


132.4 


open wound/injury of lower arm 


-158 


-1.79 


0.0741 


89 


132.5 


open wound of other sites 


316 


3.75 


0.0002 


84 


132.6 


amputation of limb/hand/foot/t 


1,762 


5.91 


0.0001 


298 


132.7 


crushing injury 


-284 


-0.69 


0.4899 


411 


132.8 


foreign body in eye/ear/nose 


62 


0.32 


0.7520 


195 


133.0 


sprains 


114 


2.10 


0.0354 


54 


134.0 


contusion, concussion, superfi 


190 


3.77 


0.0002 


50 


134.1 


accidental falls 


308 


2.63 


0.0086 


117 


134.2 


suicide/self-inflicted injury 


2,539 


3.95 


0.0001 


643 


134.3 


other accidents 


34 


0.26 


0.7929 


130 


135.0 


Intracranial injury 


12 


0.08 


0.9389 


158 


136.0 


third degree burns 


371 


0.62 


0.5348 


597 


136.1 


other burns 


818 


3.59 


0.0003 


228 


136.2 


nerve injury 


29 


0.13 


0.9004 


230 


136.3 


eariy complications of trauma/ 


172 


0.59 


0.5575 


293 


137.0 


poison effects 


444 


2.74 


0.0062 


162 


137.1 


toxic effects, named substance 


426 


2.15 


0.0313 


198 


137.2 


toxic effects of other nonmedi 


-509 


-2.38 


0.0172 


214 


137.3 


allergy, unspecified 


114 


0.79 


0.4274 


144 


137.4 


adverse effects of drugs in th 


197 


2.01 


0.0444 


98 


138.0 


malfunction of internal orthop 


113 


0.43 


0.6694 


264 


138.1 


infection/inflammation due to 


3.697 


13.48 


0.0001 


274 


138.2 


other complications of certain 


1.380 


9.99 


0.0001 


138 


138.3 


other complications of medical 


■608 


-7.06 


0.0001 


86 


138.4 


misadventure to patient in sur 


-60 


-0.20 


0.8398 


298 


139.0 


kidney/heart/lung/liver transp 


349 


0.71 


0.4788 


493 


139.1 


Other organ transplant 


•3^2 


-1.03 


0.3024 


380 



8 

dcg\finatappx-)ATat>-b3\nab 



TABLE B-3 

REGRESSION OF 1992 MEDICARE PROGRAM EXPENDITURES ON 1991 
HOSPITAL AND PHYSICIAN (ALL) DIAGNOSIS DIAGNOSTIC GROUPS 
(Ri'= 10.46%) 









T FOR HO: 




STD ERROR 


ADDXG 


LABEL 


ESTIMATE 


PARAMETER=0 

-1.41 


PR > ITI 


OF ESTIMATE 


139.2 


heart/valve replacement 


-320 


0.1593 


227 


139.3 


joint replacement 


494 


3.33 


0.0009 


148 


139.4 


other organ replacement 


553 


1.12 


0.2648 


496 


139.5 


artificial opening status/atte 


2,355 


12.53 


0.0001 


188 


139.6 


postsurgical states, eye 


1,020 


1.72 


0.0851 


592 


139.7 


other postsurgical states 


-146 


-1.87 


0.0617 


78 


139.8 


machin° dependence 


6,411 


8.52 - 


0.0001 


752 


140.0 


rehabilitation procedures 


en 


0.54 


0.5887 


111 


141.0 


radiotherapy 


507 


2.56 


0.0106 


198 


142.0 


chemotherapy 


3,425 


15.14 


0.0001 


226 


143.0 


infectious disease contact/car 


-55 


-0,14 


0°R88 


397 


143.1 


preventive 


-237 


-6.15 


0.0001 


39 


143.2 


history of malignant neoplasm 


12 


0.15 


0.8790 


82 


143.3 


history of mental dis/oth dise 


-22 


-0.17 


0,8633 


128 


143.4 


histor^ of drug allergy/oth he 


31 


0.22 


0,8236 


141 


143.5 


family history of disease 


-480 


-3.17 


0,0015 


151 


143.6 


problems of int. organs/e)ct. s 


211 


0.76 


0,4493 


279 


143.7 


elective surgery 


-804 


-1.55 


0,1217 


520 


143.8 


prothesis/other device fitting 


522 


2.25 


0,0242 


232 


143.10 


aftercare 


-291 


-2.26 


0,0240 


129 


143.11 


donor 


400 


0.73 


0,4627 


544 


143.12 


hh/fanily/other pyschosocial c 


-42 


-0.10 


0,9191 


413 


143.13 


care not delivered 


92 


0.37 


0,7129 


249 


143.14 


administrative/consultation 


168 


1.08 


0.2816 


174 


143.15 


screening for malignant neopla 


-286 


-4.61 


0.0001 


62 


143.18 


screening/observation/special 


88 


3.02 


0,0026 


29 



SOURCE: 1992 (Expenditures) and 1991 (diagnoses) Medicare claims 



9 

dcg\final\appx-)ATab-b3\nab 



TABLE B-2 

1992 MEDICARE PROGRAM EXPENDITURES AND 1991 FREQUENCY OF ENROLLEES FOR PRINCIPAL INPATIENT DIAGNOSTIC GROUPS 
(UPPER CASE LABELS) AND HOSPITAL AND PHYSICIAN (ALL) DIAGNOSTIC GROUPS (LOWER CASE UBELS) 



DXGROUP 



Label 



SYMPTOMS, SIGNS, ILL-DEFINED CONDITIONS (continued) 

124 CARDIOVASCULAR SYMPTOMS 

124.01 chest pain 

124.02 other cardiovascular symptoms 

125 URINARY SYSTEM/ABDOMINAL-PELVIS SYMPTOMS 

125.01 retention of urine 

125.02 incontinence/urethnal discharge 

125.03 other urinary system symptoms 

125.04 alxlominal/pelvis symptoms 







Standard 


Coefficient 




Mean 


Error 


of Variation 


Frequency* 


Expenditures" 


of Mean 


(X 100) 


3.339 


7,521 


264 


203 


106.981 


6.611 


46 


227 


24.782 


6.258 


95 


240 


1.020 


9.573 


550 


184 


8.715 


8.192 


174 


198 


7.459 


7,290 


160 


190 


20.465 


5.841 


95 


232 


82.736 


6.544 


52 


228 



INJURY AND POISONING 



126 VERTEBRAL INJURY 

126.01 vertebral fracture without spinal cord injury 

126.02 vertebral fracture with -,;inal cord injury 

1 27 FRACTURES OF SKULLypACE/NASAL BONE 

127.01 fractures of skulWace 

127.02 fractures of nasal bone 

128 PELVIC FRACTURE 
128.01 pelvic fracture 

129 FEMORAL FRACTURE 
129.01 femoral fracture 

130 LOWER LIMB FRACTURES 
130,01 fractures of lower limb 

131 FRACTUREOISLOCATION 

131.01 shoulder dislocation 

131.02 dislocation of hip 

131 .03 dislocation of knee 

131.04 other dislocations 

131.05 fracture of rib. closed 

131.06 hand/wnst/lower arm fracture 

131.07 other fractures 

132 INTERNAL AND/OR OPEN WOUND 

132.01 foreign body in pharynx/larynx 

132.02 heart/lung/blood vessels injury 

132.03 gi/liver/kidney/spleen/pelvis injury 
132 04 open v«)und of eye 

132.05 open v«3und/injury of lower arm 

132.06 open wound of other sites 

132.07 traumatic amputation of limtVhand/foot/toe 

132.08 crushing injury 

132.09 foreign body in eye/ear/nose 

133 SPRAINS 
133.01 sprains 

134 CONTUSIONS/ACCIDENTS/INJURY. SUPERFICIAL AND NOS 

134.01 concusskxi 

134.02 contusion/superficial injury 

134.03 accidental falls 

134.04 suicide/self-inflicted injury 

134.05 other accidents 

135 INTRACRANIAL INJURY 
135.01 intracranial injury 

136 BURNS/NERVE. SPINAL CORD INJURES 

136.01 third degree bums 

136.02 other bums 

136.03 nerve injury 

136.04 eariy complications of trauma 



663 


8,888 


603 


175 


5.279 


7.699 


211 


199 


613 


8.857 


704 


197 


145 


6,604 


1,150 


210 


1.451 


7.265 


456 


239 


802 


5.885 


405 


195 


550 


6,791 


532 


184 


2.199 


8,069 


331 


193 


4.756 


7,613 


209 


189 


10,354 


7.616 


144 


193 


869 


5,854 


377 


190 


8.349 


5.620 


139 


226 


1.333 


6,602 


318 


176 


874 


6,017 


513 


252 


425 


8,860 


871 


203 


2,585 


5,258 


232 


225 


16.995 


4.005 


78 


252 


4.584 


6.786 


199 


198 


8.337 


5,014 


127 


231 


9458 


6.170 


137 


216 


679 


6.709 


474 


184 


1.983 


7.945 


366 


206 


914 


7.020 


519 


223 


1.097 


8.011 


537 


222 


802 


5.715 


476 


235 


13,882 


4.742 


100 


250 


15.802 


6.302 


118 


235 


1.280 


12.166 


678 


199 


588 


5.069 


437 


209 


2.579 


4.565 


205 


228 


671 


7,689 


894 


301 


38,937 


4.842 


57 


231 


595 


6.968 


473 


165 


1.258 


6.562 


363 


196 


50,392 


5.861 


59 


225 


8.586 


6.779 


147 


201 


255 


12.670 


1.319 


166 


6,364 


5.400 


162 


240 


347 


6.857 


846 


230 


4,486 


7.345 


219 


200 


186 


8.819 


1.077 


167 


293 


7.494 


937 


214 


2,007 


6.380 


319 


224 


1.908 


6.864 


298 


189 


1.205 


8.746 


S04 


200 



11 

<Jcg\rinal\appx-x\Tab-b2VtBb 



TABLE B-2 

1992 MEDICARE PROGRAM EXPENDITURES AND 1991 FREQUENCY OF ENROLLEES FOR PRINCIPAL INPATIENT DIAGNOSTIC GROUPS 
(UPPER CASE LABELS) AND HOSPITAL AND PHYSICIAN (ALL) DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXGROUP 



Label 



INJURY AND POISONING (continued) 

137 POISONING/TOXIC EFFECTS 

137.01 poisoning by prescription or over-the-counter medications 

137.02 poisoning tjy specified nonmedicinal sutistances/injury by certain external causes 

137.03 poisoning by other nonmedicinal substances 

137.04 allergy, unspecified 

137.05 adverse effects of drugs in therapeutic use 

138 COMPLICATIONS OF MEDICAL PROCEDURES AND CARE 

138.01 malfunction of internal orthopedic device/graft 

138.02 infect'in/inflammation due to internal device/graft 

138.03 other ^ .amplications of certain specified medical procedures 

138 04 other complications of medical and surgical procedures, nee, (e.g , post-operative infection) 

138.05 misadventure to patient in surgery 

FACTORS INFLUENCING HEALTH STATUS/CONTACT WITH HEALTH SERVICES (V-COOE) 

139 ORGAN REPLACEMENT/TRANSPLANT/POST-SURGICAL STATES 

139.01 kidney, heart, heart valve (human/animal tissue), lung, liver tro.isplanl 

139.02 other organ transplant 

139.03 heart, heart valve replacement by artificial device 

139.04 joint replacement 

1 39. 05 other organ replacement 

139.06 artificial opening status/attention 

139.07 postsurgical states, eye 

139.08 other postsurgical states, including dialysis status 

139.09 aspirator, respirator, other machine dependence 

140 REHABILITATION PROCEDURES 
140,01 rehabilitation procedures 

141 RADIOTHERAPY 
141.01 radiation therapy 

142 CHEMOTHERAPY 
142.01 chemotherapy 

143 HISTORY OF DISEASE/AFTERCAReSCREENING 

143.01 infectious disease contact/canier 

143.02 vaccination, medical exam, other preventrve 

143.03 history of malignant neoplasm 

143.04 history of mental disorder/other disease 

143.05 history of dnjg allergy/other health hazard 

143.06 family ...oiory of disease 

143.07 problems of internal organs/external sites 

143.08 elective surgery 

143.09 prothesis/other device fitting, adjustment 

143.10 other orthopedic aftercare 

143.11 aftercare 

143.12 donor 

143. 13 household/family/other psychosocial circumstances 

143.14 care not delivered 

143.15 administrative/consultation 

143.16 screening for malignant neoplasm 

143.17 screening/observation/special exams 







Standard 


Coefficient 




Mean 


Error 


of Variation 


Frequency* 


Expenditures** 


of Mean 


(X 100) 


875 


11,010 


KS 


176 


4.203 


9,378 


265 


183 


2.600 


7,049 


368 


266 


2,149 


3,526 


211 


278 


4,842 


4.886 


173 


246 


11.376 


7.683 


143 


198 


4,082 


9.750 


282 


185 


1,635 


7.805 


344 


178 


1,509 


15,357 


803 


203 


6,035 


10,398 


269 


201 


16,277 


8.268 


146 


225 


1,184 


8,421 


543 


222 



559 


10,441 


802 


182 


430 


9,438 


1,069 


235 


681 


5.254 


447 


222 


2.107 


7,380 


325 


202 


5,015 


6,680 


180 


191 


414 


8.416 


809 


196 


3.341 


12.968 


463 


207 


285 


7.339 


758 


174 


19.067 


7.296 


112 


212 


204 


22.463 


5,438 


346 


3,312 


10,111 


326 


186 


9.305 


8.158 


169 


200 


116 


11.885 


1,602 


145 


3,087 


8,927 


312 


194 


736 


23,663 


974 


112 


2.552 


14,076 


404 


145 


1.168 


9.332 


478 


175 


625 


4.448 


463 


260 


77.117 


3,828 


35 


251 


18.740 


6.474 


99 


210 


6.291 


6.853 


185 


215 


5.063 


5.153 


159 


220 


4.333 


3.295 


130 


259 


1,295 


6.274 


420 


241 


367 


4.887 


448 


175 


1.947 


7.968 


343 


190 


2.413 


6.047 


252 


205 


6.316 


6.S05 


165 


201 


332 


6.433 


1.296 


367 


588 


6.770 


S61 


201 


1,632 


7.645 


365 


193 


3,307 


5.972 


259 


250 


29,040 


3,1« 


54 


291 


257,555 


5.190 


25 


243 



■UiMdgKed 

** Vl/«i^ad by fraction of year benefldsry was alve and ef gible for Medcara. 



SOURCE: 1992 (expendttms) and 1991 (daj^xnes) Medcara daims. 



12 
dcg\rinal\appx-)ftTab-b2ViaD 



APPENDIX C: 

DIAGNOSTIC COST GROUP 
SORTING ALGORITHM RESULTS 



TABLE C-1 

SORTING ALGORITHM OUTPUT FOR PRINCIPAL INPATIENT DCG MODEL 



PIPDC' 



PIPDXG 



PIPDXG LABEL 



23 


142 


17 


29 


17 


12 


17 


19 


17 


105 


14 


7 


14 


66 


14 


117 


14 


102 


14 


106 


14 


96 


14 


51 


14 


10 


14 


104 


12 


80 


12 


23 


12 


24 


12 


99 


12 


6 


12 


25 


12 


45 


12 


14 


10 


30 


10 


2 


10 


141 


10 


110 


10 


88 


10 


67 


10 


89 


2 


3 


10 


122 


10 


56 


10 


50 


10 


78 


10 


63 


10 


101 


10 


26 


8 


84 


8 


18 


8 


16 


8 


92 


8 


37 


8 


69 


8 


17 


8 


70 


8 


44 


8 


9 


8 


136 


8 


116 


8 


97 


8 


5 


8 


140 


8 


86 


8 


53 


8 


54 


8 


42 


8 


8 


8 


65 


8 


139 



CHEMOTHERAPY 

END STAGE LIVER DISORDERS 

HODGKIN'SDISEASE/LYMPHOMA/MYELOMA/LEUKEMIA 

SECONDARY CANCERS 

RESPIRATORY FAILURE/ARREST 

STOMACH/SMALL BOWEL/LIVER/PANCREAS/ESOPHAGUS CANCER 

POLYNEUROPATHY 

CHRONIC ULCER OF SKIN 

LUNG DISEASES DUE TO EXTERNAL AGENTS 

RENAL FAILURE 

EMPHYSEMA/CHRONIC BRONCHITIS 

OTHER BLOOD DISEASES 

LUNG CANCER 

OTHER LUNG DISEASE 

HEART FAILURE 

DIABETES WITH ACUTE COMPLICATIONS 

DIABETES WITH CHRONIC COMPLICATIONS 

GRAM-NEGATIVE/STAPHYLOCOCCUS PNEUMONIA 

MOUTH/PHARYNX/LARYNX/OTHER RESP'RATORY CANCER 

HYPOGLYCEMIA 

ARTHROPATHY/BONE INFECTION 

CANCER OF PLACENTA/OVARY/UTERINEADNEXIA 

OTHER LIVER DISORDERS 

SEPTICEMIA/SHOCK 

RADIOTHERAPY 

OTHER URINARY TRACT INFECTIONS 

ARTERIAL EMBOLISM AND THROMBOSIS 

CEREBRAL CYSTS, COMPRESSION, EDEMA, ANOXIC DAMAGE, 

PERIPHERAL VASCULAR DISEASE 

HIV/AIDS (INCLUDING PNEUMOCYTOSIS) 

FEVER 

MANIC AND DEPRESSIVE DISORDERS 

ANEMIA 

VENTRICULAR TACHYCARDIA 

OTHER NEUROLOGIC DISORDERS 

ASTHMA 

DISORDERS OF FLUID/ELECTROLYTE/ACID BASE BALANCE 

CEREBROVASCULAR DISEASE 

OTHER CANCER 

CANCER OF BLADDER/KIDNEY/URINARY ORGANS 

OTHER CIRCULATORY DISEASE 

REGIONAL ENTERITIS 

HYPERTENSION, UNCOMPLICATED 

NEOPLASM OF NERVOUS SYSTEM 

HYPERTENSION. COMPLICATED 

CONNECTIVE TISSUE DISEASES 

RECTAL CANCER 

BURNS/NERVE, SPINAL CORD INJURES 

DERMATOLOGICAL DISORDERS 

OTHER BRONCHITIS 

LATE EFFECTS 

REHABILITATION PROCEDURES 

ATHEROSCLEROSIS 

SUBSTANCE-RELATED PSYCHOSES 

DELIRIUM/HALLUCINATIONS 

GASTROINTESTINAL HEMORRHAGE 

COLON CANCER 

MONONEUROPATHY 

ORGAN REPLACEMENT/TRANSPLANT/POST-SURGICAL STATES 



FREQUENCY 


MEAN 


736 


$23,663 


136 


20,886 


350 


18,943 


849 


18,888 


1,087 


17,231 


364 


16,416 


139 


16,273 


859 


15,963 


783 


15,561 


378 


15,329 


2,292 


15,300 


533 


15,076 


669 


14,197 


475 


14,087 


7,043 


13,096 


270 


13,087 


1,909 


12,866 


1,124 


12,423 


204 


12,337 


379 


12,234 


393 


12.234 


95 


12,082 


2-'6 


11,253 


1,559 


11,117 


68 


11,037 


2,532 


10,992 


743 


10,977 


103 


10,963 


739 


10,885 


10 


10,678 


275 


10,553 


2,231 


10,475 


655 


10,320 


371 


10,257 


417 


10,101 


1,303 


10,055 


2,613 


10,006 


4,542 


9,275 


221 


9,266 


747 


9,256 


376 


9,237 


178 


9,201 


882 


9,025 


196 


9,000 


540 


8,947 


487 


8,804 


393 


8,780 


161 


8,761 


1,600 


8,673 


1,898 


8,670 


164 


8,637 


2,647 


8,636 


527 


8,627 


243 


8,506 


296 


8,486 


1,277 


8,474 


1,078 


8,442 


169 


8,439 


443 


8,329 



1 

dcg\(inal\appx-)ATab-c1 \nab 



TABLE C-1 

SORTING ALGORITHM OUTPUT FOR PRINCIPAL INPATIENT DCG MODEL 



PIPDCG PIPDXG 



PIPDXG LABEL 



8 


38 


8 


57 


8 


109 


8 


64 


8 


28 


8 


55 


8 


33 


8 


103 


8 


62 


8 


73 


7 


100 


7 


72 


7 


52 


7 


107 


7 


49 


7 


126 


7 


137 


7 


125 


7 


138 


7 


60 


6 


75 


6 


111 


6 


143 


6 


13 


6 


87 


6 


120 


6 


82 


6 


119 


6 


91 


6 


81 


6 


74 


6 


90 


6 


121 


6 


85 


6 


129 


6 


83 


6 


68 


6 


40 


6 


77 


6 


31 


5 


43 


5 


98 


5 


15 


5 


71 


5 


32 


5 


59 


5 


76 


5 


27 


5 


39 


5 


47 


5 


124 


5 


4 


5 


134 


5 


118 


5 


21 


5 


58 


5 


123 


5 


93 


5 


48 



PERITONITIS/INTESTINAL OBSTRUCTION 

PARANOIA AND OTHER PSYCHOSES 

OTHER RENAUURETERAL DISEASES 

EPILEPSY AND OTHER SEIZURE DISORDERS 

PANCREATITIS/ OTHER PANCREATIC DISORDERS 

SCHIZOPHRENIC DISORDERS 

GASTRITIS/OTHER GASTRIC DISORDERS 

PLEURISY/PNEUMOTHORAX 

DEGENERATIVE NEUROLOGIC DISORDERS 

OTHER ACUTE ISCHEMIA 

BACTERIAL PNEUMONIA 

ACUTE MYOCARDIAL INFARCTION 

DEMENTIA 

KIDNEY INFECTION 

OTHER BONE DISORDERS 

VERTEBRAL INJURY 

POISONING/TOXIC EFFECTS 

URINARY SYSTEM/ABDOMINAL-PELVIS SYMPTOMS 

COMPLICATIONS OF MEDICAL PROCEDURES AND CARE 

OTHER MENTAL DISORDERS 

PULMONARY HEART DISEASE 

OTHER URINARY DISORDERS 

HISTORY OF DISEASE/AFTERCARE/SCREENING 

CANCER OF UTERUS/CERVIX/FEMALE GENITAL ORGANS 

ANEURYSM 

GENERAL SYMPTOMS 

CEREBRAL HEMORRHAGE 

CONGtNITAL ANOMALIES 

HYHOTENSION (LOW BLOOD PRESSURE) 

OTHER CARDIAC DISEASE 

ANGINA PECTORIS 

THROMBOPHLEBITIS 

COMA/ SYNCOPE 

TRANSIENT CEREBRAL ISCHEMIA 

FEMORAL FRACTURE 

PRECEREBRAL ARTERIAL OCCLUSION 

VALVULAR AND RHEUMATIC HEART DISEASE 

ANAURECTAL/GASTROINTESTINAL DISORDERS 

ATRIAL ARRYTHMIA 

DISEASES OF ESOPHAGUS 

GOUT/ARTHROPATHY/DERANGEMENTS 

VIRAL PNEUMONIA/INFLUENL , 

CANCER OF PROSTATEH-ESTIS/MALE GENITAL ORGANS 

MYOCARDIAL INFARCTION 

ULCERS 

SUBSTANCE ABUSE AND DEPENDENCE 

RHYTHM AND CONDUCTION DISORDERS 

OTHER ENDOCRINE/NUTRITIONAUMETABOLIC DISEASES 

DIVERTICULA OF INTESTINE 

BACK PAIN 

CARDIOVASCULAR SYMPTOMS 

OTHER INFECTIOUS AND PARASITIC DISEASES 

CONTUSIONS/ACCIDENTS/INJURY, SUPERFICIAL AND NOS 

OTHE," DEMATOLOGICAL DISORDERS 

CARCINOMA IN SITU/NEOPLASM OF UNCERTAIN BEHAVIOR 

NEUROTIC DISORDERS 

RESPIRATORY/OTHER CHEST SYMPTOMS 

DISORDERS OF THE EYE AND ADNEXA 

DISORDERS OF SOFT TISSUES 



FREQUENCY 


MEAN 


1,821 


8,296 


446 


8,252 


267 


8,236 


954 


8,186 


692 


8,181 


1.383 


8,132 


1,397 


8,118 


307 


8,069 


326 


8,033 


5,906 


8,001 


4,564 


7,243 


3,074 


7,243 


733 


7,204 


437 


7,159 


1,015 


7,100 


435 


7,076 


503 


7,072 


677 


7,071 


2,604 


7,061 


447 


7,014 


324 


6,714 


414 


6,688 


572 


6,679 


301 


6,675 


594 


6.635 


493 


6,492 


253 


6,473 


80 


6,438 


297 


6,436 


260 


6,378 


1,266 


6,353 


807 


6,348 


1,531 


6,335 


1,686 


6,229 


2,858 


6,173 


993 


6,125 


450 


6,092 


1,192 


6,087 


2,024 


6,023 


724 


6,001 


313 


5,855 


226 


5,775 


1,418 


5,711 


1,684 


5,709 


1,376 


5,707 


499 


5,645 


1,647 


5,589 


373 


5,518 


1.297 


5,513 


2,001 


5,439 


2,080 


5,351 


771 


5,316 


361 


5,274 


115 


5,267 


269 


5.245 


190 


5,226 


225 


5,197 


844 


5,063 


434 


5,037 



dcg\final\appx-x\Tab-c1 \nab 



TABLE C-1 

SORTING ALGORITHM OUTPUT FOR PRINCIPAL INPATIENT DCG MODEL 

PIPDCG PIPDXG PIPDXG LABEL 



5 


95 


5 


128 




36 




133 




135 




61 




131 




35 




46 




79 




41 




34 




108 




11 


3 


132 


3 


112 


3 


130 


3 


20 


2 


22 


2 


1 


3 


113 


3 


94 


3 


127 


2 





2 


115 


2 


114 



NOSE/ THROAT DISEASES 

PELVIC FRACTURE 

ABDOMINAL HERNIA/ UNCOMPLICATED 

SPRAINS 

INTRACRANIAL INJURY 

HEADACHES 

FRACTURE/DISLOCATION 

ABDOMINAL HERNIA/ COMPLICATED 

OSTEOARTHRITIS 

HEART ARREST/ SHOCK 

GALLBLADDER DISORDERS 

APPENDICITIS 

RENAL/URETERAL/BLADDER CALCULUS 

BREAST CANCER 

INTERNAL AND/OR OPEN WOUND 

PROSTATE/TESTICUL^R/PENILE DISORDERS 

LOWER LIMB FRACTURES 

BENIGN NEOPLASMS 

DIABETES WITHOUT COMPLICATIONS 

CENTRAL NERVOUS SYSTEM INFECTION (E.G., MENINGITIS) 

DISEASES OF FEMALE GENITAL ORGANS 

EAR DISORDERS 

FRACTURES OF SKULUFACE/NASAL BONE 

NO INPATIENT CUMMS 

PREGNANCY/PERINATAL CONDITIONS 

GENITAL PROLAPSE 



FREQUENCY 


MEAN 


350 


5,027 


305 


5,015 


1,123 


4,790 


446 


4,738 


160 


4,722 


102 


4,719 


809 


4,539 


307 


4,415 


2,454 


4.352 


12 


4,260 


2,623 


4,244 


242 


4,242 


683 


4,222 


1,120 


4,049 


356 


3.968 


2588 


3.963 


576 


3.886 


586 


3.802 


42 


3.801 


43 


3.775 


524 


3.629 


431 


3,287 


82 


3.119 


554,125 


2.869 


95 


2.449 


911 


2.434 



NOTE: The sorting algorithm ouput is illLtstrated in tl-ie furtherrrcst right-hand (rrean) colurm. 
SOURCE; 1992 (expenditures) and 1991 (diagnoses) Medicare claims. 



3 

dcg\final\appx-x\TatM;1\nab 



TABLE C-2 

SORTING ALGORITHM OUTPUT FOR HOSPITAL AND PHYSICIAN (ALL) DIAGNOSIS DOG MODEL 



ADDCG ADDXG 



LABEL 



17 


139.09 


17 


105.02 


14 


29.01 


14 


19.02 


14 


29.02 


14 


106.02 


14 


7.01 


14 


7.04 


14 


51.03 


14 


138.02 


14 


102.02 


14 


104.03 


12 


89.07 


10 


99.01 


10 


134.04 


10 


24.01 


10 


27.09 


10 


2.01 


10 


25.01 


10 


63.04 


10 


63.03 


10 


19.03 


10 


6.02 


10 


106.03 


10 


142.01 


10 


3.01 


10 


12.04 


10 


10.01 


10 


51.02 


10 


7.05 


8 


59.02 


8 


104.04 


8 


104.01 


8 


24.02 


8 


66.04 


8 


66.02 


8 


84.03 


8 


53.02 


8 


54.01 


8 


53.01 


8 


132.07 


8 


12.02 


8 


84.02 


8 


78.01 


7 


75.02 


7 


139.06 


7 


95.05 


7 


105.01 


7 


72.01 


7 


106.01 


7 


106.04 


7 


68.03 


7 


80.01 


7 


89.06 


7 


68.01 


7 


7.03 


7 


88.01 


6 


126.02 


6 


131.02 


6 


62.05 



aspirator, respirator, other mactilne dependence 

respiratory arrest 

end stage liver disorders 

secondary cancer of respiratory and digestive systems 

esophageal varices 

acute renal failure 

cancer of esophagus 

cancer of liver 

aplastic anemia 

infection/inflammation due to internal device/grafl 

aspiration pneumonia 

acute lung edema nos 

gangrene 

gram-negative/staph pneumonia 

suicide/self-inflicted injury 

diabetes with renal manifestation 

protein-calorie malnutrition 

septicemia/shocl< 

hypoglycemic coma 

paraplegia 

quadriplegia 

secondary cancer of other site 

cancer of pharynx 

chronic renal failure 

chemotherapy 

HIV/AIDS (including pneumocytosis) 

myeloid leukemia 

lung cancer 

acquired hemolytic anemia 

cancer of pancreas 

drug dependence 

post trauma/surgery pulmonary insufficiency 

empyema/abscess of lung 

diabetes \mth other specified complications 

muscular dystrophies 

inflammatory/toxic neuropathy 

aphasia (loss of language skills/comprehension) 

drug psychoses 

delirium/delusions/hallucinations 

alcoholic psychoses 

traumatic amputation of limb/hand/foot/toe 

multiple myeloma 

hemiplegia (paralysis of one side of body) 

ventric tachycardia 

other pulmonary heart disease 

artificial opening status/attention 

paralysis of vocal cords/larynx 

respiratory failure 

acute myocardial infarction 

nephritis, dialysis encounter 

renal failure, unspecified 

mitral/aortic valve disorders 

heart failure 

vascular insufficiency of intestines 

rheumatic fever/heart disease 

cancer of small \xme\ 

arterial embolism and thrombosis (blood clots) 

vertebral fracture with spinal cord injury 

dislocation of hip 

autonomic nerve disorder 



FREQUENCY 


MEAN 


204 


$22,463 


2,333 


19,696 


716 


15,714 


2,964 


15,540 


413 


15,039 


1,957 


14,860 


374 


14,826 


589 


14,799 


1,462 


14,771 


1,456 


14,568 


1,679 


14,327 


1,890 


14,194 


2,084 


12,222 


1,804 


11,593 


220 


11,418 


951 


1 1 ,394 


3,122 


11,298 


4.863 


1 1 ,203 


520 


11,178 


650 


1 1 ,092 


558 


10,880 


3.683 


10,716 


514 


10,483 


2,792 


10,474 


1,688 


10,377 


405 


10,287 


339 


10,200 


3,649 


10,199 


380 


10,152 


405 


10,090 


675 


8,807 


572 


8,683 


449 


8,604 


6,715 


8,483 


594 


8,313 


2,085 


8,254 


1,294 


8,251 


635 


8,175 


2,778 


8,146 


814 


8,126 


726 


8,111 


609 


8,104 


4,459 


8,090 


3,199 


8,037 


3,675 


7,450 


1,596 


7,423 


285 


7,421 


9,584 


7,366 


3,947 


7,344 


1,057 


7,268 


1,722 


7,262 


3,966 


7,204 


42,021 


7,118 


734 


7,063 


2,523 


7,041 


272 


7,028 


3,477 


7,017 


307 


6,267 


242 


6,250 


591 


6,057 



dcgVinal\appx-x\Tab-c2\nab 



TABLE C-2 

SORTING ALGORITHM OUTPUT FOR HOSPITAL AND PHYSICIAN (ALL) DIAGNOSIS DCG MODEL 



ADDCG ADDXG 



LABEL 



6 


19.01 


6 


12.03 


6 


60.01 


5 


93.02 


5 


139.01 


5 


121.01 


5 


138.03 


5 


87.01 


5 


30.01 


5 


6.01 


5 


119.01 


5 


63.05 


5 


4.07 


5 


117.01 


5 


54.02 


5 


138.01 


5 


128.01 


5 


17.02 


5 


63.08 


5 


62.06 


5 


5.02 


5 


57.01 


5 


38.01 


5 


19.04 


5 


56.01 


5 


18.01 


5 


62.03 


5 


73.01 


5 


89.03 


5 


28.02 


5 


62.01 


5 


27.12 


5 


67.01 


5 


7.02 


5 


129.01 


5 


57.02 


5 


82.01 


5 


59.01 


5 


87.02 


5 


12.01 


5 


24.03 


4 


38.02 


5 


86.01 


5 


84.01 


5 


62.04 


5 


71.01 


5 


27.04 


5 


139.07 


5 


92.03 


5 


89.04 


5 


17.03 


5 


16.01 


5 


125.01 


5 


51.07 


5 


126.01 


5 


143.12 


5 


143.09 


5 


139.04 


5 


52.01 


5 


32.02 



secondary cancer of lymph node 

lymphoid leukemia 

personality disorders 

proliferative diabetic retinopathy 

kidney, heart, heart valve (human/animal tissue), lung, liver transplant 

coma 

other complications of certain specified medical procedures 

aortic aneurysm 

cintiosis 

cancer of mouth/tongue 

spina bifida, other congenital anomalies of nervous system 

CdUda equina syndrome 

bacterial infection in other diseases 

chronic ulcer of skin 

hallucinations, symptomatic 

malfunction of internal orthopeaic aevice/graft 

pelvic fracture 

cancer of the brain/nervous system/pituitary, pineal glands 

other central nervous system disorders 

Tay-Sachs, other hereditary and degenerative cen'— I nervous system diseases 

cerebrovascular disease late effects 

paranoid states 

intestinal obstruction 

disseminated cancer 

manic and depressive disorders 

cancer of bone and articular cartilage 

anterior horn cell disease 

other acute ischemia 

peripheral vascular disease 

chronic pancreatitis/other pancreatic diseases 

Parkinson's disease 

disorders of plasma protein metabolism 

cerebral cysts, compression, edema, anoxic damage, other brain conditions 

cancer of stomach 

femoral fracture 

other nonorganic psychoses 

cerebral hemorrhage 

alcohol dependence 

other aneurysm 

lymphoma/Karposi's sarcoma/Hodgkin's Diseasp 

diabetes with unspecified complications 

peritonitis 

atherosclerosis of major vessel 

cerebrovascular accident (stroke) 

other spinal cord disease 

myocardial infarction 

adrenal gland disorders 

postsurgical states, eye 

other circulatory disease/postphlebitic syndrome 

other arterial disease 

benign neoplasm brain/nervous system/pituitary, pineal glands 

cancer of bladder/kidney/urinary organs 

retention of urine 

immune disorders 

vertebral fracture without spinal cord Injury 

donor 

prothesls/other device fitting, adjustment 

joint replacement 

senile/presenile psychoses 

ulcer with perforation 



FREQUENCY 


MEAN 


6Z3 


6,053 


841 


6,053 


1,202 


6,029 


824 


5,985 


138 


5,949 


905 


5,883 


2,261 


5,811 


3,106 


5,800 


870 


5,796 


518 


5,775 


507 


5,724 


1,551 


5,707 


3,782 


5,684 


8,263 


5,680 


294 


5,617 


874 


5,599 


1,224 


5,575 


981 


5,527 


586 


5,488 


365 


5,457 


3,205 


5,441 


386 


5,433 


4,780 


5,433 


462 


5,411 


7,233 


5,400 


467 


5,397 


209 


5,392 


8,182 


5,385 


13,486 


5,383 


1,269 


5,366 


5,318 


5,344 


538 


5,313 


1,796 


5,313 


281 


5,288 


5,589 


5,282 


5,698 


5,281 


1,202 


5,272 


1,279 


5,271 


760 


5,253 


1,388 


5,252 


6,826 


5,251 


77 


5,247 


8,125 


5,246 


16,510 


5,245 


582 


5,223 


3,920 


o,z21 


668 


5,209 


186 


5,194 


2,561 


5,192 


2,915 


5,187 


978 


5.187 


3,345 


5,165 


4,301 


5,160 


394 


5,146 


2,970 


5,136 


221 


5,136 


914 


5,136 


3,291 


5,134 


7,613 


5,123 


456 


5,120 



dcg\final\appx-x\Tab-c2\nab 



TABLE C-2 

SORTING ALGORITHM OUTPUT FOR HOSPITAL AND PHYSICIAN (ALL) DIAGNOSIS DCG MODEL 



ADDCG ADDXG LABEL 



5 


38.03 


5 


136.01 


5 


137.01 


5 


93.01 


5 


100.01 


5 


26.01 


5 


71.02 


5 


89.01 


5 


132.03 


5 


45.02 


5 


106.05 


5 


52.03 


5 


66.01 


5 


51.04 


5 


81.04 


4 


7.06 


4 


21.01 


4 


139.03 


4 


139.05 


4 


14.01 


4 


9.01 


4 


123.02 


4 


52.04 


4 


6.03 


3 


15.01 


3 


116.02 


3 


18.05 


3 


7401 


3 


27.06 


3 


81.01 


3 


96.01 


3 


52.02 


3 


15.02 


3 


20.02 


3 


81.03 


3 


37.01 


3 


63.06 


3 


131.01 


3 


44.02 


3 


119.03 


3 


75.01 


3 


123.01 


3 


134.01 


3 


34.01 


3 


77.01 


3 


51.05 


3 


109.02 


3 


81.05 


3 


85.01 


3 


98.01 


3 


71.03 


3 


18.02 


3 


121.02 


3 


40.03 


3 


101.01 


3 


4.14 


3 


70.05 


3 


115.02 


3 


132.01 


3 


70.03 



other peritoneal disorders 

third degree bums 

poisoning by prescription or over-the-counter medications 

diabetic retinopathy 

specific bacterial pneumonia 

disorders of fluid/electrolyte/acid-base balance 

old myocardial infarction 

specified peripheral vascular disease 

gi/liver/kidney/spleen/pelvis Injury 

osteomyelitis 

impaired renal function 

cerebral degeneration/Alzheimer's disease 

peripheral neuropathy 

hemophilia and other coagulation defects 

cardiomegaly (enlarged heart) 

oirier cancer of digestive organs/periiuueum 

carcinoma in situ of digestive organs 

heart, heart valve replacement by artificial device 

other organ replacement 

cancer of ovaries/placenta/uterine adne-ia 

rectal cancer 

hemoptysis (coughing up blood) 

senility without psychosis 

cancer of larynx 

prostate cancer 

bullous dermatoses 

thyroid/endocrine cancer 

angina per»'^ris 

testicui"' dysfunction 

pericarditis, post-MI 

emphysema/chronic bronchitis 

other organic psychotic conditions 

cancer of testis/male genital organs 

benign neoplasm of respiratory system 

cardiomyopathy/myocarditis 

regional enteritis (Crohn's disease) 

other paralytic disorders 

shoulder dislocation 

rheumatoid arthritis and other inflammatory polyarihropathy 

congenital anomalies of cardiac/circulatory systems 

pulmonary embolism (blood clot) 

dyspnea (labored breathing)/other reso abnormalities 

concussion 

appendicitis 

atrial arrhythmia 

purpura/lhrombocytopathy/hemorrhagic conditions 

hydronephrosis/other renal/urethral disorders 

other heart disease 

transient cerebral ischemia 

viral pneumonia 

other chronic ischemic heart disease 

cancer of connective and other soft tissue 

syncope (fainting) and collapse 

Intestinal at)cess/ulceration/perforation 

asthma 

thrush 

hypertension encephalopathy 

pregnancy writh abortive outcome 

foreign body in pharynx/larynx 

hypertensive heart and renal disease 



FREQUENCY 


MEAN 


657 


5,112 


177 


5,108 


1,667 


5,102 


5,302 


5,090 


992 


5,086 


17,135 


5,077 


4,554 


5,070 


1,264 


5,053 


601 


5,052 


1,643 


5,033 


511 


5,028 


6,568 


5,019 


2,585 


5,014 


2,276 


5,013 


7,546 


5,008 


119 


4,704 


380 


4,400 


335 


4371 


93 


4,292 


313 


4,070 


1,496 


4,054 


586 


4,041 


233 


4,039 


355 


4,003 


5,246 


3,964 


248 


3,913 


181 


3,877 


11,435 


3,739 


224 


3,735 


295 


3,727 


23,083 


3,722 


325 


3,711 


100 


3,711 


189 


3,708 


1,310 


3,708 


475 


3,684 


159 


3,684 


398 


3,656 


6,080 


3,611 


1,798 


3,605 


330 


3,548 


11,922 


3,531 


334 


3,530 


198 


3,512 


7,546 


3,511 


731 


3,506 


2,673 


3,488 


3,131 


3,476 


3,022 


3,475 


422 


3,469 


36,176 


3,463 


282 


3,460 


4,266 


3,458 


694 


3,457 


8,780 


3,451 


251 


3,438 


184 


3,435 


76 


3,432 


575 


3,430 


500 


3,425 




3 


dcg\final\appx-x'iTab-c2\nab 



TABLE C-2 

SORTING ALGORITHM OUTPUT FOR HOSPITAL AND PHYSICIAN (ALL) DIAGNOSIS DCG MODEL 



ADDCG ADDXG 



3 


135.01 


3 


139.08 


3 


44.01 


3 


68.02 


3 


83.01 


3 


70.02 


3 


131.03 


3 


138.04 


3 


8.01 


3 


100.02 


3 


4.04 


3 


140.01 


3 


.5.02 


3 


41.02 


3 


12.05 


3 


109.01 


3 


95.04 


3 


119.04 


3 


55.01 


3 


21.04 


3 


21,03 


3 


35.01 


3 


60.07 


3 


13.02 


3 


27.15 


3 


102.01 


3 


104.05 


3 


63.01 


3 


51.08 


3 


92.01 


3 


131.05 


3 


41.01 


3 


118.04 


3 


127,02 


3 


27.08 


3 


86,02 


3 


60,06 


3 


49,02 


3 


92,04 


3 


10,06 


3 


76.01 


3 


23.01 


3 


50.01 


3 


143.08 


3 


22.01 


3 


102.03 


3 


90.02 


3 


104.02 


3 


111.01 


3 


103.01 


3 


60.05 


3 


63.07 


3 


91.01 


3 


28.01 


3 


4.13 


3 


76.02 


3 


51.06 


3 


42.01 


3 


143.14 


3 


41.03 



LABEL 



intracranial injury 

other postsurgical states, Including dialysis status 

systemic lupus eryttiematosus and other connective tissue disease 

mitral or aortic valve/endocardia disease 

precerebral arterial occlusion 

malignant hypertensive heart disease 

dislocation of knee 

other complications of medical and surgical procedures, nee, (e.g., post-operative infection) 

colon cancer 

other pneumonia 

tuberculosis 

rehabilitation procedures 

incontinence/urethral discharge 

biliary tract disease 

other leukemia 

urethral stricture 

larynxA^ocal cord diseases 

congenital anomalies of musculoskeletal/limb 

schizophrenic disorders 

neoplasm of uncertain behavior, specified sites 

carcinoma in situ of other sites 

abdominal hernia, complicated 

depression, not elsevrfiere classified 

cancer of cervix/female genital organs 

other hyperalimentation 

bronchiectasis, lung diseases due to specified external agent 

other lung disease 

multiple sclerosis, other central nervous system dymelinalion 

other blood disease 

superficial phlebitis-leg 

fracture of rib, closed 

cholelithiasis (gallstones) 

diseases of nail 

fractures of nasal txine 

miscellaneous endocrine disorders 

atherosclerosis/general, ascvd 

nonpsychotic organic brain syndrome 

other bone disorders (e.g., curvature of spine, Paget's disease) 

other specified circulatory disorders 

other/ill-defined site cancer 

conduction disorders/cardiac dysrhythmias 

diabetes with acute complications 

iron deficiency and other anemias 

elective surgery 

diabetes without complications 

respiratory conditions due to other external agents/postinflammatory fibrosis 

noninfectious lymphatic disorders 

pulmonary congestion/hypostasis 

other urinary disorders 

pleurisy/pneumothorax 

adjustment reaction 

nervous/musculoskeletal system symptoms 

hypotension (low blood pressure) 

acute pancreatitis 

dermatophytosis (fungal skin infections, e.g., athlete's foot) 

premature heart beats 

white blood cell disorders 

gastrointestinal hemorrhage 

care not delivered 

other gallbladder disorders 



FREQUENCY 


MEAN 


998 


3,415 


3,881 


3,410 


1,770 


3,407 


6,180 


3,401 


2,693 


3,398 


1,055 


3,363 


1,370 


3,358 


2,411 


3.348 


1,237 


3 340 


7,183 


3,336 


601 


3,332 


1,686 


3,331 


1,991 


3,329 


202 


3,318 


131 


3,318 


2,076 


3,311 


729 


3,310 


2,109 


3,309 


3,635 


3,306 


1,509 


3,305 


1,950 


3,300 


429 


3,299 


3,182 


3.297 


582 


3,293 


177 


3,287 


896 


3,285 


5,094 


3,281 


548 


3,270 


1,723 


3,270 


523 


3,268 


1,483 


3.255 


2,236 


3,254 


1 1 ,626 


3,250 


277 


3,243 


697 


3,239 


10,424 


3,232 


961 


3,230 


6,731 


3,222 


1,686 


3,208 


1,807 


3,206 


17,472 


3,198 


552 


3,197 


16,205 


3,193 


144 


3,179 


31,190 


3,177 


1,469 


3,172 


384 


3,165 


1,848 


3,161 


8,802 


3,159 


1,601 


3,158 


1,055 


3,157 


1,767 


3,152 


1,007 


3,142 


388 


3,138 


15,388 


3,131 


3,592 


3,129 


802 


3,108 


6,902 


3,106 


399 


3,098 


2,936 


3,091 



dcg\finalAappx-x\Tab-c2Viab 



TABLE C-2 

SORTING ALGORITHM OUTPUT FOR HOSPITAL AND PHYSICIAN (ALL) DIAGNOSIS DCG MODEL 



ADDCG 


ADDXG 

49.01 


LABEL 


FREQUENCY 


MEAN 


3 


osteoporosis 


5,120 


3,091 


3 


116.01 


cellulltls/abscess/other local skin Infection 


13,379 


3,091 


3 


141.01 


radiation therapy 


732 


3,087 


3 


37.02 


ulcerative colitis 


566 


3,083 


3 


32.01 


ulcer without perforation 


6,733 


3,066 


3 


122.01 


fever 


1,992 


3,064 


3 


124.01 


chest pain 


34,317 


3,055 


3 


46.01 


osteoarthrosis 


49,046 


3,054 


3 


123.04 


respiratory/other chest symptoms 


7,715 


3,051 


3 


125.04 


abdominal/pelvis symptoms 


23,947 


3,047 


3 


40.04 


other intestinal disorders 


9,199 


3,046 


3 


43.02 


other arthropathy/]oint disorders, derangements 


43,593 


3,041 


3 


95.08 


salivary gland diseases 


761 


3,027 


3 


66.03 


myoneural disorders/myasthenia gravis 


189 


3,018 


3 


30.02 


other liver disorders 


1,851 


3,014 


3 


4.01 


bacterial enteritis (intestinal infections) 


178 


3,003 


2 


60.02 


sexual deviations and disorders 


139 


2,771 


2 


65.04 


root/plexus lesions 


79 


2,681 


1 


65.05 


other cranial nerve disorders 


24 


2,565 


2 


93.08 


vitreous hemon-hage 


130 


2,475 


2 


60.11 


other mental disorders 


110 


2,373 


2 


132.08 


crushing injury 


67 


2,350 


1 


20.05 


benign neoplasm of urinary 


21 


2,281 


1 


4.10 


viral hepatitis 


25 


2.180 


2 


134.03 


accidental falls 


385 


2,173 


2 


44.04 


polymyalgia rheumatica 


169 


2,154 


1 


132.02 


heart/lung/blood vessels injury 


18 


2,098 


2 


21.06 


unspecified neoplasm 


1,189 


2,078 


2 


60.04 


acute reaction to stress 


103 


2,071 


2 


119.05 


congenital anomalies of skin 


187 


2,017 


2 


65.01 


trigeminal nerve disorder 


121 


2,007 




137.02 


poisoning by specified nonmedicinal substances/injury by certain external causes 


157 


1,939 




112.02 


other prostatic disorders 


1,286 


1,933 




65.06 


neuropathy of upper limb (e.g., carpal tunnel syndrome) 


437 


1,900 




136.02 


other bums 


203 


1,885 




127.01 


fractures of skull/face 


51 


1,874 




43.01 


gout/crystal arthropathy 


1,189 


1,868 




118.01 


dennatitis due to internal agent 


63 


1,852 




115.01 


pregnancy/birth complications, mother/child 


313 


1,851 




11.01 


breast cancer 


1,230 


1,848 




108.01 


renal/ureteral/bladder calculus (e.g., kidney stones) 


339 


1,828 




112.01 


hyperplasia of prostate 


3,994 


1,806 




39.01 


divercula of Intestine 


1,570 


1,797 




33.02 


gastritis/other gastric disorder (stomach disorders) 


3,365 


1,791 




49.04 


other acquired limb deformities 


171 


1,780 




69.02 


hypertensive heart disease 


1,596 


1,763 




131.07 


other fractures 


551 


1,763 




18.04 


skin cancer, except melanoma 


3,608 


1,758 




64.01 


epilepsy and other seizure disorders 


1,381 


1,744 




113.04 


female stress incontinence 


196 


1,743 




93.04 


retinal disorders 


7,167 


1,728 




18.03 


melanoma 


126 


1,725 




143.03 


history of malignant neoplasm 


1,103 


1,723 




118.02 


psoriasis and similar disorders 


565 


1,721 




94.01 


Impacted earwax 


3,749 


1,713 




95.07 


other diseases of upper respiratory system 


960 


1,712 




20.01 


tienign neoplasm of digestive system 


1,031 


1,704 




21.05 


neoplasm of uncertain behavior nec/nos 


1,576 


1,697 




61.01 


headaches, including migraine 


1.732 


1,695 




124.02 


other cardiovascular symptoms 


924 


1,688 



dcgVina [\appx-x\Ta b-c2\na b 



TABLE C-2 

SORTING ALGORITHM OUTPUT FOR HOSPITAL AND PHYSICIAN (ALL) DIAGNOSIS DCG MODEL 



ADDCG ADDXG 



LABEL 



115.03 

36.01 

47.01 

110.01 

132.04 

125.03 

120.04 

27.10 

70.01 

93.05 

120.03 

112.03 
94.05 
98.02 

132.06 

143.04 
20.07 
59.0? 
93.06 
40.02 
65.07 
4.09 

120.02 
4.15 

132.05 
97.01 

113.01 
95.03 
94.04 

137.05 

118.03 

131.06 

119.07 
31.01 

123.03 

48.01 

93.09 

4.05 

40.01 

132.09 

134.02 

143.07 
27.05 
92.02 
62.02 

131.04 
69.01 

114.01 
95.02 

137.04 
27.13 

133.01 
20.03 

118.05 
95.01 

130.01 
27.14 

143.11 
58.01 
44.03 



normal pregnancy/delivery 

abdominal hernia/uncomplicated 

back disorders (e.g., slipped disk, lumbago, sciatica, backache) 

cystitis, other urinary tract Infections 

open wound of eye 

other urinary system symptoms 

other general symptoms 

vitamin/other nutritional deficiencies 

malignant hypertension 

glaucoma 

malaise and fatigue 

pc -JsAestis/male genital organs disorders 

other ear disorders 

Influenza 

open wound of other sites 

history of mental disorder/other oisease 

other benign neoplasms 

non-dependent abuse of drugs 

cataract/lens replacement 

anal/rectal disorders 

neuropathy of leg 

herpes simplex 

dizziness and giddiness 

mycoses (fungal diseases), miscellaneous 

open wound/injury of lower arm 

other bronchitis 

diseases of female pelvic organs 

chronic sinusitis 

hearing loss 

adverse effects of drugs in therapeutic use 

other dermatosis 

hand/wrist/lower arm fracture 

other congenital anomalies 

disease of esophagus 

cough 

disorders of soft tissue 

other eye disorders 

strep throat/scarlet fever 

hemorrhoids 

foreign body in eye/ear/nose 

contusion/superficial injury 

problems of internal organs/extei . <al sites 

ovarian dysfunction 

varicose veins 

Huntington's Disease, other abnormal movement disorders 

other dislocations 

essential hypertension 

genital prolapse 

nasal polyps/allergic riiinltis 

allergy, unspecified 

disorders of mineral metabolism 

sprains 

benign neoplasm of skin 

other dermatological disorders 

acute noseAhroat infection 

fractures of lower limb 

cystic fibrosis, metabolism disorders, nec/nos 

aftercare 

neurotic disorders (e.g. anxiety, panic attack, phobias) 

inflammatory spondylopathies 



FREQUENCY 


MEAN 


45 


1,688 


1,350 


1,687 


7,065 


1,677 


4,794 


1,676 


73 


1,675 


1,095 


1,672 


7,038 


1,672 


210 


1,669 


1,844 


1,662 


9,082 


1,658 


1,779 


1,657 


730 


1,656 


2,551 


1,653 


1,041 


1,643 


1,312 


1,635 


209 


1,634 


1,074 


1,633 


168 


1,631 


27,364 


1,628 


1,208 


1,627 


328 


1,625 


210 


1,624 


2,187 


1,617 


167 


1,604 


1,727 


1,603 


6,830 


1,600 


324 


1,594 


2,157 


1,593 


1,942 


1.592 


319 


1,592 


6,718 


1,585 


861 


1,581 


241 


1,574 


1,086 


1.574 


1,371 


1.573 


7,012 


1.571 


17,426 


1.570 


158 


1.570 


1,402 


1,570 


413 


1,568 


3,637 


1,562 


116 


1,558 


277 


1,556 


608 


1,553 


199 


1,544 


2,667 


1,640 


29,411 


1,536 


854 


1,530 


2,523 


1,529 


507 


1,526 


132 


1,514 


4,009 


1,510 


2,716 


1,494 


10,085 


1,491 


9,643 


1,487 


659 


1,486 


151 


1,484 


372 


1,475 


1,722 


1,474 


132 


1,469 



6 

dcgyinal\appx-x\Tab-c2\nab 



TABLE C-2 

SORTING ALGORITHM OUTPUT FOR HOSPITAL AND PHYSICIAN (ALL) DIAGNOSIS DCG MODEL 

ADDCG ADDXG LABEL 

1 1 9.02 congenital anomalies of eye 

93.03 endophthalmitis (eye inflammation) 

94.03 vertiginous syndromes 
5.01 infection late effects 

94.02 otitis media (middle ear Infection) 

1 43.02 vaccination, medical exam, other preventive 

20.06 benign neoplasm of eye 
143.17 screening/observation/special exams 
1 20.01 somatic/segmental dysfunction 
1 07.01 kidney infection 

90.01 phlebitis and thrombophlebitis 
4.08 herpes zoster 

4.1 1 other viral infections 

21 .02 carcinoma in situ of respiratory system 
95.09 oral soft tissue/tongua^aw disorders 

33.01 py.o.ic/duodenal obstruction 

25.02 other hypoglycemia 
0.00 NO CLAIMS IN ANY DATA 

143.1 5 administrative/consultation 

1 3.01 cancer of uterus 

93.07 disorders of refraction and accommodation (e.g., far-, near-sightedness, astigmatism) 
1 43.1 3 household/family/other psychosocial circumstances 

89.02 Raynaud's syndrome 

51 .01 sickle cell and other hereditary hemolytic anemias 

27.03 thyroid disorders 

49.03 flat foot, acquired deformities of toe 
27.1 1 disorders of lipoid metabolism (high cholesterol) 

66.05 other neuropathy 
1 1 3.03 other diseases of female genital organs 

4.03 other intestinal infections 

1 .01 central nervous system infection (e.g., meningitis) 

20.04 benign neoplasm of breast 

1 43.01 infectious disease contact/carrier 
60.09 developmental behavioral disorders 

63.02 infantile cerebral palsy 

27.01 goiter 

27.02 thyrotoxicosis 
4.16 other infections 

1 1 3.05 menopausal and postmenopausal disorders 

1 43.06 family history of disease 

65.03 root/plexus disorders 

1 39.02 other organ transplant 

95.06 disorders of teeth and jaw/ 
27.16 obesity/localized adiposity 

143.10 other orthopedic aftercare 

134.05 other accidents 

1 1 3.02 vaginal and cervical diseases 
1 7.01 cancer of the eye 

4.06 other t>acterjal Infections 

4.02 viral enteritis (Intestinal infections) 
1 43.05 history of drug allergy/ottier healtti hazard 

1 43.1 6 screening for malignant neoplasm 

79.01 heart an'est/shock 

1 36.03 nerve Injury 

89.05 disease of capillaries 

27.07 other endocrine disorders 

5.03 injury late effects 

65.02 facial nerve disorders 
137.03 poisoning by other nonmedicinal substances 

4.12 late syphilis, symptomatic 



FREQUENCY 


MEAN 


342 


1,464 


42 


1,454 


1,112 


1,447 


35 


1,443 


2,296 


1,437 


12,215 


1,423 


172 


1,421 


19,227 


1,416 


1,668 


1,415 


120 


1,413 


320 


1,412 


891 


1,404 


1,538 


1,403 


14 


1,378 


403 


1,361 


3 


1,357 


113 


1,352 


75,226 


1,337 


265 


1.335 


151 


1,326 


4,724 


1,302 


33 


1,300 


63 


1,285 


36 


1,284 


3,223 


1,281 


612 


1,280 


1 1 ,429 


1,274 


69 


1,267 


746 


1,264 


91 


1,239 


71 


1,236 


11,050 


1,223 


78 


1,220 


63 


1,207 


160 


1,194 


381 


1,194 


486 


1,193 


583 


1,176 


4,281 


1,154 


611 


1,148 


36 


1,134 


55 


1,132 


561 


1,130 


457 


1,108 


99 


1,097 


551 


1,086 


1,932 


1,077 


38 


1,047 


99 


1,045 


100 


1,043 


493 


1,041 


4,436 


1,033 


35 


1,033 


92 


1,026 


101 


998 


258 


972 


65 


971 


120 


938 


346 


905 


10 


854 




7 


dcg\final\appx-x\Tab-c2\nab 



TABLE C-2 

SORTING ALGORITHM OUTPUT FOR HOSPITAL AND PHYSICIAN (ALL) DIAGNOSIS DCG MODEL 

ADDCG ADDXG LABEL 

60.08 behavior disorder 
60. 1 mental retardation 

90.03 hemorrhage nos 

81 .02 acute endo/myocardltis 

90.04 compression of vein 

1 38.05 misadventure to patient in surgery 
1 36.04 early complications of trauma 

70.04 secondary hypertension 

60.03 psychophysiologic disorders 

1 1 9.06 chromosomal anomalies 
45.01 arthropathy y»nth infection 

6.04 other respiratory/intrathoracic cancer 

NOTE: The sorting algorithm ouput is illustrated in the furthermost right-hand (mean) column. 
SOURCE: 1992 (expenditures) and 1991 (diagnoses) Medicare claims. 



FREQUENCY 


MEAN 


55 


821 


641 


785 


14 


709 


10 


637 


11 


604 


14 


578 


51 


578 


33 


576 


41 


560 


134 


452 


36 


318 


16 


300 



8 

dcg\final\appx-)rtTab-c2\nab 



TABLE C-3 

SORTING ALGORITHM OUTPUT FOR EXPANDED DCG MODEL (PRINCIPAL INPATIENT DIAGNOSES ARE IN UPPER CASE) 



EDCG 



EDXG 



LABEL 



23 


142 


17 


139.09 


17 


29 


17 


105.02 


17 


12 


17 


19 


17 


105 


14 


7 


14 


117 


14 


106 


14 


51 


14 


66 


14 


96 


14 


29.01 


14 


106.02 


14 


29.02 


14 


102 


14 


138.02 


14 


7.01 


12 


10 


12 


104.03 


12 


19.02 


12 


23 


12 


80 


12 


24 


12 


104 


10 


134.04 


10 


102.02 


10 


67 


10 


45 


10 


27.09 


10 


99 


10 


99.01 


10 


89 


10 


2.01 


10 


89.07 


10 


110 


10 


25.01 


10 


6 


10 


88 


10 


63.04 


10 


51.03 


10 


25 


10 


56 


10 


2 


10 


6.02 


8 


78 


8 


101 


8 


50 


8 


16 


8 


19.03 


8 


10.01 


8 


53 


8 


12.04 



CHEMOTHERAPY 

aspirator, respirator, ottier machine dependence 

END STAGE LIVER DISORDERS 

respiratory arrest 

HODGKIN'S DISEASE/LYMPHOMA/MYELOMA/LEUKEMIA 

SECONDARY CANCERS 

RESPIRATORY FAILURE/ARREST 

STOMACH/SMALL BOWEL/LIVER/PANCREAS/ESOPHAGUS CANCER 

CHRONIC ULCER OF SKIN 

RENAL FAILURE 

OTHER BLOOD DISEASES 

POLYNEUROPATHY 

EMPHYSEMA/CHRONIC BRONCHITIS 

end stage liver disorders 

acute renal failure 

esophageal varices 

LUNG DISEASES DUE TO EXTERNAL AGENTS 

infection/inflammation due to internal device/graft 

cancer of esophagus 

LUNG CANCER 

acute lung edema nos 

secondary cancer of respiratory and digestive systems 

DIABETES WITH ACUTE COMPLICATIONS 

HEART FAILURE 

DIABETES WITH CHRONIC COMPLICATIONS 

OTHER LUNG DISEASE 

suicide/self-inflicted injury 

aspiration pneumonia 

CEREBRAL CYSTS, COMPRESSION, EDEMA, ANOXIC DAMAGE, 

ARTHROPATHY/BONE INFECTION 

protein-calorie malnutrition 

GRAM-NEGATIVE/STAPHYLOCOCCUS PNEUMONIA 

gram-negative/staph pneumonia 

PERIPHERAL VASCULAR DISEASE 

septicemia/shock 

gangrene 

OTHER URINARY TRACT INFECTIONS 

hypoglycemic coma 

MOUTH/PHARYNX/LARYNX/OTHER RESPIRATORY CANCER 

ARTERIAL EMBOLISM AND THROMBOSIS 

paraplegia 

aplastic anemia 

HYPOGLYCEMIA 

MANIC AND DEPRESSIVE DISORDERS 

SEPTICEMIA/SHOCK 

cancer of pharynx 

VENTRICULAR TACHYCARDIA 

ASTHMA 

ANEMIA 

CANCER OF BLADDER/KIDNEY/URINARY ORGANS 

secondary cancer of other site 

lung cancer 

SUBSTANCE-RELATED PSYCHOSES 

myeloid leukemia 



FREQUENCY 


MEAN 


736 


$23,663 


204 


22,463 


136 


20,886 


2,318 


19,626 


350 


18,943 


849 


18,888 


1,087 


17,231 


354 


16,331 


855 


15,968 


368 


15,149 


526 


15.104 


132 


14,686 


2,129 


14,596 


597 


14,505 


1,882 


14,495 


351 


14,413 


732 


14,309 


1,399 


14,043 


328 


14,023 


607 


13,335 


1,634 


12,922 


1,983 


12,840 


243 


12,474 


6,530 


12,464 


1,815 


12,288 


378 


12,066 


219 


11,314 


873 


11,262 


90 


11.207 


304 


1 1 ,066 


2,888 


10,967 


952 


10,944 


1,610 


10,781 


695 


10,713 


4,544 


10,551 


1,555 


10,535 


2,403 


10,461 


444 


10,418 


167 


10.414 


692 


10.410 


588 


10,331 


916 


10,281 


297 


10,274 


2,176 


10,188 


1,379 


10,125 


459 


10,024 


331 


9,981 


1,153 


9,820 


506 


9,061 


674 


8,956 


2,774 


8,954 


2,611 


8,695 


210 


8,682 


271 


8,635 



1 

dcg\final\appx-x\Tal)-c3\nab 



TABLE C-3 

SORTIN'^ ALGORITHM OUTPUT FOR EXPANDED DCG MODEL (PRINCIPAL INPATIENT DIAGNOSES ARE IN UPPER CASE) 

EDCG EDXG LABEL 



8 


17 


8 


84 


8 


63 


8 


92 


8 


24.01 


8 


18 


8 


106.03 


8 


122 


8 


12.02 


8 


54 


8 


97 


8 


51.02 


8 


104.04 


8 


^09 


8 


7.05 


8 


57 


8 


116 


8 


37 


7 


119 


8 


26 


8 


140 


8 


84.03 


8 


44 


8 


69 


8 


55 


8 


3.01 


8 


64 


7 


5 


7 


7.04 


7 


52 


7 


103 


7 


73 


7 


136 


7 


74 


7 


125 


7 


60 


7 


42 


7 


86 


6 


30 


6 


66.04 


6 


19.01 


6 


54.01 


6 


93.02 


6 


24.02 


6 


72.01 


6 


68 


6 


49 


6 


88.01 


6 


126 


6 


63.03 


6 


139.06 


6 


132.07 


6 


38 


6 


95.05 



NEOPLASM OF NERVOUS SYSTEM 

CEREBROVASCULAR DISEASE 

OTHER NEUROLOGIC DISORDERS 

OTHER CIRCULATORY DISEASE 

diabetes with renal manifestation 

OTHER CANCER 

chronic renal failure 

FEVER 

multiple myeloma 

DELIRIUM/HALLUCINATIONS 

OTHER BRONCHITIS 

acquired hemolytic anemia 

post trauma/surgery pulmonary insufficiency 

OTHER RENAUURETERAL DISEASES 

cancer of pancreas 

PARANOIA AND OTHER PSYCHOSES 

DERMATOLOGICAL DISORDERS 

REGIONAL ENTERITIS 

CONGENITAL ANOMALIES 

DISORDERS OF FLUID/ELECTROLYTE/ACID BASE BALANCE 

REHABILITATION PROCEDURES 

aphasia (loss of language skills/comprehension) 

CONNECTIVE TISSUE DISEASES 

HYPERTENSION, UNCOMPLICATED 

SCHIZOPHRENIC DISORDERS 

HIV/AIDS (including pneumocytosis) 

EPILEPSY AND OTHER SEIZURE DISORDERS 

U^TE EFFECTS 

cancer of liver 

DEMENTIA 

PLEURISY/PNEUMOTHORAX 

OTHER ACUTE ISCHEMIA 

BURNS/NERVE, SPINAL CORD INJURES 

ANGINA PECTORIS 

URINARY SYSTEM/ABDOMINAL-PELV.„ ...PIOMS 

OTHER MENTAL DISORDERS 

GASTROINTESTINAL HEMORRHAGE 

ATHEROSCLEROSIS 

OTHER LIVER DISORDERS 

muscular dystrophies 

secondary cancer of lymph node 

deliriunVdelusions/halluclnations 

proliferative diatjetic retinopathy 

diabetes with other specified complications 

acute myocardial infarction 

VALVULAR AND RHEUMATIC HEART DISEASE 

OTHER BONE DISORDERS 

arterial embolism and thromtxjsis (blood clots) 

VERTEBRAL INJURY 

quadriplegia 

artificial opening status/attention 

traumatic amputation of limb/hand/footAoe 

PERITONITIS/INTESTINAL OBSTRUCTION 

paralysis of vocal cords/larynx 



FREQUENCY 


MEAN 


180 


8,612 


4,080 


8,564 


289 


8,559 


326 


8,554 


651 


8,526 


200 


8,421 


2,126 


8,414 


168 


8,413 


659 


8,410 


282 


8,357 


1,760 


8,336 


277 


8,321 


520 


8,235 


237 


8,231 


289 


8,184 


434 


8,178 


1,366 


8,167 


139 


8,142 


83 


8,139 


1,802 


8,138 


2,279 


8,135 


1,239 


8,111 


449 


8,090 


785 


8,076 


1,347 


8,047 


325 


8,042 


844 


8,029 


59 


7,725 


193 


7,305 


669 


7,210 


212 


7,198 


4,970 


7,158 


105 


7,123 


1,539 


7.105 


642 


7,100 


408 


7,081 


976 


7,081 


317 


7,009 


109 


6,765 


455 


6,752 


733 


6,723 


1,402 


6,712 


1,154 


6,712 


4,908 


6.663 


3,238 


6,654 


393 


6,644 


880 


6,539 


2,587 


6,534 


386 


6,510 


0.8 


6,459 


1,391 


6,451 


564 


6,436 


1,254 


6,422 


249 


6,393 



2 

dcg\final\appx-x\Tab-c3\nab 



TABLE C-3 

SORTING ALGORITHM OUTPUT FOR EXPANDED DCG MODEL (PRINCIPAL INPATIENT DIAGNOSES ARE IN UPPER CASE) 

EDCG EDXG LABEL 



6 


121 


6 


70 


6 


62.03 


6 


87.01 


6 


131.02 


6 


9 


6 


100 


6 


126.02 


6 


106.04 


6 


72 


6 


62 


6 


80.01 


6 


53.01 


6 


138.03 


6 


138 


6 


62.05 


6 


107 


6 


117.01 


6 


8 


6 


104.01 


6 


78.01 


6 


138.01 


6 


89.06 


6 


19.04 


6 


12.03 


6 


81 


6 


137 


6 


66.02 


6 


87.02 


6 


38.02 


6 


12.05 


6 


139 


6 


53.02 


6 


143 


6 


63.05 


6 


85 


6 


84.02 


6 


30.01 


6 


136.01 


5 


139.01 


5 


58 


5 


98 


5 


120 


S 


59 


5 


59.02 


S 


75 


5 


91 


5 


61 


5 


83 


5 


65 


5 


18.01 


4 


121.01 


4 


82 


4 


128.01 



COMA/ SYNCOPE 

HYPERTENSION, COMPLICATED 

anterior horn cell disease 

aortic aneurysm 

dislocation of hip 

RECTAL CANCER 

BACTERIAL PNEUMONIA 

vertebral fracture with spinal cord injury 

renal failure, unspecified 

ACUTE MYOCARDIAL INFARCTION 

DEGENERATIVE NEUROLOGIC DISORDERS 

neart failure 

alcoholic psychoses 

other complications of certain specified medical procedures 

COMPLICATIONS OF MEDICAL PROCEDURES AND CARE 

autonomic nerve disorder 

KIDNEY INFECTION 

chronic ulcer of skin 

CO! ON CANCER 

empyema/abscess of lung 

ventric tachycardia 

malfunction of internal orthopedic device/graft 

vascular insufficiency of intestines 

disseminated cancer 

lymphoid leukemia 

OTHER CARDIAC DISEASE 

POISONINGH-OXIC EFFECTS 

inflammatory/toxic neuropathy 

other aneurysm 

peritonitis 

other leukemia 

ORGAN REPUVCEMENT/TRANSPLANT/POST-SURGICAL STATES 

drug psychoses 

HISTORY OF DISEASE/AFTERCARBSCREENING 

Cauda equina syndrome 

TRANSIENT CEREBRAL ISCHEMIA 

hemiplegia (paralysis of one side of body) 

cirrhosis 

third degree bums 

kidney, heart, heart valve (human/animal tissue), lung, liver transplant 

NEUROTIC DISORDERS 

VIRAL PNEUMONIA/INFLUENZA 

GENERAL SYMPTOMS 

SUBSTANCE ABUSE AND DEPENDENCE 

drug dependence 

PULMONARY HEART DISEASE 

HYPOTENSION (LOW BLOOD PRESSURE) 

HEADACHES 

PRECEREBRAL ARTERIAL OCCLUSION 

MONONEUROPATHY 

cancer of bone and articular cartilage 

coma 

CEREBRAL HEMORRHAGE 

pelvic fracture 



FREQUENCY 


MEAN 


1,472 


6,390 


353 


6,388 


254 


6,386 


3,959 


6,340 


275 


6,339 


246 


6,324 


3,571 


6,314 


374 


6,305 


1,421 


6,295 


2,564 


6,286 


202 


6,262 


33,496 


6,254 


440 


6,233 


3,057 


6,225 


2,035 


6,212 


781 


6,203 


331 


6,202 


10,091 


6,185 


643 


6,178 


313 


6.162 


1,869 


6,161 


1,091 


6,160 


479 


6,157 


585 


6,151 


946 


6,151 


242 


6,142 


358 


6,138 


1,516 


6,133 


1,016 


6,125 


391 


6,120 


521 


6,120 


282 


6,104 


320 


6,101 


582 


6,095 


1,817 


6,087 


1,582 


6.053 


1,848 


6,024 


1,042 


6,021 


157 


6,001 


128 


5,628 


143 


5,533 


131 


5,318 


278 


5,285 


298 


5,213 


259 


5,212 


121 


5,177 


142 


5,175 


89 


5,157 


562 


5,049 


88 


5,026 


394 


5,016 


577 


4,967 


108 


4,946 


93? 


4,907 




3 


dog\final\appx-x\Tab-c3\nab 



TABLE C-3 

SORTING ALGORITHM OUTPUT FOR EXPANDED DCG MODEL (PRINCIPAL INPATIENT DIAGNOSES ARE IN UPPER CASE) 



EDCG 



EDXG 



LABEL 



4 


15.02 


4 


111 


4 


13 


4 


129.01 


4 


32.02 


4 


71 


4 


89.03 


4 


47 


4 


S7.01 


4 


123.02 


4 


134 


4 


62.01 


4 


28 


4 


86.01 


4 


92.03 


4 


93.01 


4 


119.01 


4 


14.01 


4 


54.02 


4 


43 


4 


16.01 


4 


105.01 


4 


5.02 


4 


6.01 


4 


38.01 


4 


84.01 


4 


27.12 


4 


73.01 


4 


90 


4 


31 


4 


75.02 


4 


106.01 


4 


82.01 


4 


129 


4 


O8.03 


4 


71.02 


4 


20.02 


4 


7.03 


4 


75.01 


4 


28.02 


4 


89.04 


4 


33 


4 


71.01 


4 


77 


4 


139.04 


4 


24.03 


4 


15.01 


4 


143.14 


4 


12.01 


4 


119.03 


4 


139.03 


4 


128 


4 


52.01 


4 


66.01 



cancer of testis/male genital organs 

OTHER URINARY DISORDERS 

CANCER OF UTERUS/CERVIX/FEMALE GENITAL ORGANS 

femoral fracture 

ulcer with perforation 

MYOCARDIAL INFARCTION 

peripheral vascular disease 

BACK PAIN 

cerebral cysts, compression, edema, anoxic damage, other brain conditions 

hemoptysis (coughing up blood) 

CONTUSIONS/ACCIDENTS/INJURY, SUPERFICIAL AND NOS 

Parkinson's disease 

PANCREATITIS/ OTHER PANCREATIC DISORDERS 

atherosclerosis of major vessel 

other circulatory disease/postphlebitic syndrorr.c 

diabetic retinopathy 

spina bifida, other congenital anomalies of nervous system 

cancer of ovaries/placenta/uterine adnexia 

hallucinations, symptomatic 

GOUT/ARTHROPATHY/DERANGEMENTS 

cancer of bladder/kidney/urinary organs 

respiratory failure 

cerebrovascular disease late effects 

cancer of mouth/tongue 

intestinal obstruction 

cerebrovascular accident (strol<e) 

disorders of plasma protein metabolism 

other acute ischemia 

THROMBOPHLEBITIS 

DISEASES OF ESOPHAGUS 

other pulmonary heart disease 

nephritis, dialysis encounter 

cerebral hemorrhage 

FEMORAL FRACTURE 

mitral/aortic valve disorders 

old myocardial infarction 

benign neoplasm of respiratory system 

cancer of small bowel 

pulmonary embolism (blood clot) 

chronic pancreatitis/other pancreatic diseases 

other arterial disease 

GASTRITIS/OTHER GASTRIC DISORDERS 

myocardial Infarction 

ATRIAL ARRYTHMIA 

joint replacement 

diabetes with unspecified complications 

prostate cancer 

care not delivered 

lymphoma/KarposFs sarcoma/Hodgkin's Disease 

congenital anomalies of cardiac/circulatory systems 

heart, heart valve replacement by artiflcial device 

PELVIC FRACTURE 

senile/presenile psychoses 

peripheral neuropathy 



FREQUENCY 


MEAN 


163 


4,836 


239 


4,819 


180 


4,807 


4,051 


4.796 


377 


4.785 


980 


4,783 


10,715 


4,773 


1,429 


4.766 


1,255 


4,766 


873 


4.757 


243 


4.752 


4,320 


4,739 


303 


4,732 


6,393 


4,730 


1,963 


4,72b 


4,302 


4,724 


391 


4,722 


469 


4,696 


214 


4,689 


209 


4,685 


2,687 


4,681 


4,406 


4,674 


2,213 


4,668 


413 


4,667 


2,894 


4,666 


1 1 ,937 


4,658 


413 


4,657 


4,530 


4,640 


393 


4,635 


468 


4631 


1,613 


4,630 


578 


4619 


825 


4,619 


1,490 


4,608 


1,671 


4,599 


3,458 


4,599 


382 


4.598 


151 


4.588 


589 


4,580 


1.064 


4.578 


2,141 


4,b/b 


605 


4.574 


2,916 


4,567 


914 


4,527 


2,233 


4,518 


5 021 


4,501 


/,897 


4,486 


709 


4,486 


1,228 


4,484 


3,128 


4,482 


697 


4,479 


227 


4,478 


5,527 


4,461 


2,182 


4,460 



dcg\final\appx-x\Tab-c3\nab 



TABLE C-3 

SORTING ALGORITHM OUTPUT FOR EXPANDED DCG MODEL (PRINCIPAL INPATIENT DIAGNOSES ARE IN UPPER CASE) 



EDCG 



EDXG 



LABEL 



4 


68.01 


4 


32 


4 


20.05 


4 


18.02 


4 


15 


4 


81.01 


4 


63.08 


4 


7.02 


4 


9.01 


4 


139.07 


4 


76 


4 


106.05 


4 


125.01 


4 


17.03 


4 


27.04 


4 


51.05 


4 


81.04 


4 


74.01 


4 


116.02 


4 


83.01 


4 


52.02 


4 


37.01 


4 


41.02 


4 


51.04 


4 


56.01 


4 


139.05 


4 


126.01 


4 


39 


4 


52.03 


4 


21.04 


4 


28.01 


4 


57.02 


4 


121.02 


4 


81.03 


4 


134.03 


4 


85.01 


4 


21.01 


4 


89.01 


4 


62.06 


4 


17.02 


4 


4 


4 


68.02 


4 


131.05 


4 


96.01 


4 


123.01 


4 


103.01 


4 


102.03 


4 


18.06 


4 


98.01 


4 


46 


4 


52.04 


4 


132.03 


4 


77.01 


4 


143.09 



rheumatic fever/heart disease 

ULCERS 

benign neoplasm of urinary 

cancer of connective and other soft tissue 

CANCER OF PROSTATE/TESTIS/MALE GENITAL ORGANS 

pericarditis, post-MI 

other central nervous system disorders 

cancer of stomach 

rectal cancer 

postsurgical states, eye 

RHYTHM AND CONDUCTION DISORDERS 

impaired renal function 

retention of urine 

benign neoplasm brain/nervous system/pituitary, pineal glands 

adrenal gland disorders 

purpura/thrombocytopathy/hemorrhagic crnditions 

cardiomegaly (enlarged heart) 

angina pectoris 

bullous dermatoses 

precerebral arterial occlusion 

other organic psychotic conditions 

regional enteritis (Crohn's disease) 

biliary tract disease 

hemophilia and other coagulation defects 

manic and depressive disorders 

other organ replacement 

vertebral fracture without spinal cord injury 

DIVERTICUU OF INTESTINE 

cerebral degeneration/Alzheimer's disease 

neoplasm of uncertain behavior, specified sites 

acute pancreatitis 

other nonorganic psychoses 

syncope (fainting) and collapse 

cardiomyopathy/myocarditis 

accidental falls 

transient cerebral ischemia 

carcinoma In situ of digestive organs 

specified peripheral vascular disease 

Tay-Sachs, other hereditary and degenerative central nervous system diseases 

cancer of the brain/nervous systern/pltuitary, pineal glands 

OTHER INFECTIOUS AND PARASITIC DISEASES 

mitral or aortic valve/endocardia disease 

fracture of rib, closed 

emphysema/chronic bronchitis 

dyspnea (labored breathlng)/other resp abnormalities 

pleurisy/pneumothorax 

respiratory conditions due to other external agents/postinflammatory fibrosis 

other/ill-defined site cancer 

viral pneumonia 

OSTEOARTHRITIS 

senility w/ithout psychosis 

gi/Iiver/kidney/spleen/pelvis Injury 

atrial arrhythmia 

prothesis/other device fitting, adjustment 



FREQUENCY 


MEAN 


1,096 


4,456 


882 


4,451 


396 


4,450 


430 


4,450 


850 


4,434 


544 


4,433 


404 


4,415 


218 


4,414 


1,928 


4,405 


129 


4,401 


914 


4,397 


415 


4,382 


3,080 


4,380 


733 


4,364 


498 


4,358 


1,117 


4,351 


5,810 


4.342 


18,760 


4,340 


358 


4,319 


5,784 


4,316 


828 


4,311 


685 


4,311 


503 


4,306 


1,877 


4,302 


5.336 


4,302 


156 


4,298 


2,123 


4,291 


866 


4.283 


4,707 


4,270 


2.671 


4.270 


941 


4,266 


3,806 


4,264 


7,235 


4,261 


2,337 


4,260 


4,299 


4,241 


6,509 


4.241 


515 


4,240 


960 


4,218 


288 


4.211 


718 


4,201 


474 


4,194 


11,039 


4,189 


2.432 


4.186 


33,666 


4,184 


18,731 


4,179 


2,694 


4,179 


2,489 


4,170 


2,954 


4,168 


609 


4,168 


2,031 


4,160 


595 


4,160 


492 


4,158 


12,750 


4,157 


721 


4,157 



dcg\final\appx-x\Ta b-c3\na b 



TABLE C-3 

SORTIt.^ ALGORITHM OUTPUT FOR EXPANDED DCG MODEL (PRINCIPAL INPATIENT DIAGNOSES ARE IN UPPER CASE) 



EDCG 



EDXG 



LABEL 



4 


140.01 


4 


124 


4 


81.05 


4 


142.01 


4 


66.03 


4 


109.02 


4 


33.01 


4 


26.01 


4 


23.01 


4 


133 


4 


40.03 


4 


132.01 


4 


62,04 


4 


139.08 


4 


60.06 


4 


102.01 


4 


6.03 


4 


34.01 


4 


63.07 


4 


131 


4 


44.01 


4 


125.02 


4 


40 


4 


8.01 


4 


63.06 


4 


71.03 


4 


4.14 


4 


44.02 


4 


90.02 


4 


143.12 


4 


51.08 


4 


118.04 


4 


137.01 


4 


4.07 


4 


91.01 


4 


123 


4 


51.06 


4 


104.05 


2 


48 


2 


70.05 


2 


27.15 


2 


70.03 


2 


45.02 


2 


38.03 


2 


119.04 


2 


134.01 


2 


131.01 


2 


135.01 


2 


59.01 


2 


136.03 


2 


131.03 


2 


55.01 


1 


27 


2 


45.01 



rehabilitation procedures 

CARDIOVASCULAR SYMPTOMS 

other heart disease 

chemotherapy 

myoneural disorders/myasthenia gravis 

hydronephrosis/other renal/urethral disorders 

pyloric/duodenal obstruction 

disorders of fluid/electrolyte/acid-base tia'^nce 

diabetes with acute complications 

SPRAINS 

inteE*:nal abcess/ulceralic: "'jration 

foreign body in pharynx/larynx 

other spinal cord disease 

other postsurgical states, including dialysis status 

nonpsychotic organic brain syndrome 

bronchiectasis, lung diseases due to specifieu e, 'srnal agent 

cancer of larynx 

appendicitis 

nervous/muscuioskeletal system symptoms 

FRACTURE/DISLOCATION 

systemic lupus erythematosus and other connective tissue disease 

incontinence/urethral discharge 

ANAL/RECTALyGASTROINTESTINAL DISORDERS 

colon cancer 

other paralytic disorders 

other chronic ischemic heart disease 

thrush 

rheumatoid arthritis and other inflammatory polyarthropathy 

noninfectious lymphatic disorders 

donor 

other blood disease 

diseases of nail 

poisoning by prescription or over-the-counter medications 

bacterial infection in other diseases 

hypotension {\ow blood pressure) 

RESPIRATORY/OTHER CHEST SYMPTOMS 

white blood cell disorders 

other lung disease 

DISORDERS OF SOFT TISSUES 

hypertension encephalopathy 

other hyperalimentation 

hypertensive heart and renal disease 

osteomyelitis 

other peritoneal disorders 

congenital anomalies of musculoskeletal/IImb 

concussion 

shoulder dislocation 

Intracranial injury 

alcohol dependence 

nerve injury 

dislocation of knee 

schizophrenic disorders 

OTHER ENDOCRINE/NUTRITIONAL/METABOLIC DISEASES 

arthropathy wnth infection 



FREQUENCY 


MEAN 


2.851 


4,155 


1,490 


4,154 


5,636 


4,151 


538 


4,146 


270 


4,144 


4,753 


4,143 


218 


4,138 


11,069 


4,133 


994 


4,131 


388 


4,127 


1,198 


4,125 


902 


4.113 


449 


4,113 


6,980 


4,108 


2,839 


4,089 


1.338 


4,086 


461 


4,078 


376 


4,077 


3,636 


4,077 


623 


4,076 


2,722 


4,076 


3,497 


4,074 


718 


4,073 


2,412 


4,069 


340 


4,067 


58,513 


4,045 


390 


4,042 


8,450 


4,042 


597 


4,042 


166 


4.036 


2,765 


4,024 


21,106 


4,017 


1,201 


4,015 


1,826 


4,012 


1,852 


4,009 


139 


4,009 


1,295 


4,008 


8,291 


4,001 


70 


3,219 


69 


3,099 


104 


2,975 


214 


2,948 


330 


2,913 


104 


2,903 


1,050 


2,861 


124 


2,847 


189 


2,846 


470 


2,837 


?41 


2,835 


318 


2,765 


747 


2,746 


2,554 


2,715 


1 


2,710 


152 


2,707 



dcg\final\appx-x\Tab-c3\nab 



TABLE C-3 

SORTING ALGORITHM OUTPUT FOR EXPANDED DOG MODEL (PRINCIPAL INPATIENT DIAGNOSES ARE IN UPPER CASE) 

EDCG EDXG LABEL 



2 


141.01 


2 


51.07 


2 


22.01 


2 


60.07 


2 


109.01 


2 


27.06 


2 


93 


2 


41.01 


2 


70.02 


2 


107.01 


2 


21.03 


2 


49.01 


2 


86.02 


2 


93.08 


2 


46.01 


2 


11 


2 


35.01 


2 


65.04 


2 


4.13 


2 


49.02 


2 


37.02 


2 


65.05 


2 


60.11 


2 


4.10 


2 


18.03 


2 


100.02 


2 


119.05 


2 


43.02 


2 


125.04 


2 


111.01 


2 


50.01 


2 


131.07 


2 


116.01 


2 


127.01 


2 


93.03 


2 


76.01 


2 


41.03 


2 


76.02 


2 


92.01 


2 


60.04 


2 


25.02 


2 


70.01 


2 


11.01 


2 


27.13 


2 


44.03 


2 


60.02 


2 


69.02 


2 


136.02 


2 


123.04 


2 


124.01 


2 


113.04 


2 


4.01 


2 


95.08 


2 


112.01 



radiation therapy 

Immune disorders 

diabetes without complications 

depression, not elsewhere classified 

urethral stricture 

testicular dysfunction 

DISORDERS OF THE EYE AND ADNEXA 

cholelithiasis (gallstones) 

malignant hypertensive heart disease 

l<idney infection 

carcinoma in situ of other sites 

osteoporosis 

atherosclerosis/general, ascvd 

vitreous hemorrhage 

osteoarthrosis 

BREAST CANCER 

abdominal hernia, complicated 

root/plexus lesions 

dermatophytosis (fungal sl<in infections, e.g., athlete's foot) 

other bone disorders (e.g., curvature of spine, Paget's disease) 

ulcerative colitis 

other cranial nerve disorders 

other mental disorders 

viral he^ titis 

mel:. .oma 

other pneumonia 

congenital anomalies of skin 

other arthropathy/joint disorders, derangements 

at)dominal/pelvis symptoms 

other urinary disorders 

iron deficiency and other anemias 

other fractures 

cellulitis/abscess/other local skin infection 

fractures of skull/face 

endophthalmitis (eye inflammation) 

conduction disorders/cardiac dysrhythmias 

other gallbladder disorders 

premature heart beats 

superficial phlebitis-leg 

acute reaction to stress 

other hypoglycemia 

malignant hypertension 

breast cancer 

disorders of mineral metabolism 

Inflammatory spondylopathies 

sexual deviations and disorders 

hypertensive heart disease 

other bums 

respiratory/other chest symptoms 

chest pain 

female stress incontinence 

bacterial enteritis (intestinal infections) 

salivary gland diseases 

hyperplasia of prostate 



FREQUENCY 


MEAN 


198 


2,685 


119 


2.6S4 


18,094 


2.623 


1,732 


2.618 


923 


2.592 


111 


2,586 


140 


2,581 


1,000 


2.579 


543 


2,570 


424 


2,561 


845 


2,521 


2.563 


2,518 


4,116 


2,507 


266 


2,502 


27,099 


2,498 


201 


2,497 


186 


2,495 


176 


2,492 


6,900 


2,467 


3,333 


2,465 


283 


2,460 


54 


2,453 


273 


2,453 


87 


2.450 


325 


2,442 


2,652 


2,437 


601 


2,424 


23,692 


2,424 


14,340 


2,411 


4,054 


2,406 


7,258 


2,404 


1,576 


2,401 


6,646 


2,388 


176 


2,388 


91 


2,377 


6,019 


2,367 


1,274 


2,367 


1,217 


2,349 


248 


2.347 


322 


2,341 


434 


2.336 


4,593 


2.33fi 


3,411 


2,33.S 


484 


2,331 


446 


2.326 


385 


2.325 


4,379 


2.325 


474 


2,323 


3,432 


2,320 


13,541 


2,319 


668 


2,316 


72 


2,313 


390 


2,313 


9,862 


2,313 




7 


dcg\rinal\appx-x\Tab-c3\nab 



TABLE C-3 

SORTING ALGORITHM OUTPUT FOR EXPANDED DCG MODEL (PRINCIPAL INPATIENT DIAGNOSES ARE IN UPPER CASE) 



EDGG 



EDXG 



LABEL 



2 


47.01 


2 


101.01 


2 


42.01 


2 


57.01 


2 


63.01 


2 


27.08 


2 


60.05 


2 


44.04 


1 


20.06 


2 


36.01 


2 


33.02 


2 


65.01 


2 


32.01 


2 


65.06 


2 


112.03 


2 


58.01 


2 


92.04 


2 


13.02 


2 


143.04 


2 


20.01 


2 


90.01 


2 


95.04 


2 


40.02 


2 


21.06 


2 


40.04 


2 


120.03 


2 


138.04 


2 


36 


2 


31.01 


2 


43.01 


2 


49.03 


2 


4.02 


1 


131.04 


1 


1.01 


2 


137.04 


2 


130.01 


2 


112.02 


2 


110.01 


2 


30.02 


2 


134.02 


2 


119.07 


2 


4.06 


1 


27.14 


2 


120.02 


2 


95.09 


2 


122.01 


2 


13.01 


2 


132.02 


2 


132.04 


2 


95.07 


2 


124.02 


2 


108.01 


2 


48.01 


2 


143.01 



back disorders (e.g., slipped disk, lumbago, sciatica, backache) 

asthma 

gastrointestinal hemorrhage 

paranoid states 

multiple sclerosis, other central nervous system dymellnation 

miscellaneous endocrine disorders 

adjustment reaction 

polymyalgia rheumatica 

benign neoplasm of eye 

abdominal hernia/uncomplicated 

gastritis/other gastric disorder (stomach disorders) 

trigeminal nerve disorder 

ulcer without perforation 

neuropathy of upper limb (e.g., carpal tunnel syndrome) 

penis/testis/male genital organs disorders 

neurotic disorders (e.g. anxiety, panic attack, ph. bias) 

other specified circulatory disorders 

cancer of cervix/female genital organs 

history of mental disorder/other disease 

benign neoplasm of digestive system 

phlebitis and thrombophlebitis 

larynx/vocal cord diseases 

anal/rectal disorders 

unspecified neoplasm 

other intestinal disorders 

malaise and fatigue 

other complications of medical and surgical procedures, nee, (e.g., post-operative infect 

ABDOMINAL HERNIA/ UNCOMPLICATED 

disease of esophagus 

gout/crystal arthropathy 

flat foot, acquired deformities of toe 

viral enteritis (intestinal infections) 

other dislocations 

central nervous system infection (e.g., meningitis) 

allergy, unspecified 

fractures of lower limb 

other prostatic disorders 

cystitis, other urinary tract infections 

other liver disorders 

contusion/superficial injury 

other congenital anomalies 

other bacterial Infections 

cystic fibrosis, metabolism disorders, nec/nos 

dizziness and giddiness 

oral soft tissue/tongue/jaw disorders 

fever 

cancer of uterus 

heart/lung/blood vessels Injury 

open wound of eye 

other diseases of upper respiratory system 

other cardiovascular symptoms 

renal/ureteral/bladder calculus (e.g., kidney stones) 

disorders of soft tissue 

Infectious disease contact/carrier 



FREQUENCY 


MEAN 


23,060 


2,308 


3,278 


2,303 


2,969 


2,302 


77 


2,296 


354 


2,?94 


386 


2,292 


596 


2,292 


676 


2,291 


22 


2,289 


5,302 


2,286 


14,597 


2,286 


286 


2,284 


3,151 


2,281 


1,528 


2,279 


1,876 


2,279 


5,349 


2,278 


781 


2.277 


308 


2,277 


695 


2.277 


3,611 


2,276 


1,070 


2,276 


301 


2,276 


4,397 


2,274 


3,236 


2,274 


4,799 


2.270 


6,078 


2,264 


865 


2,264 


186 


2,264 


4,443 


2,256 


3,092 


2,255 


2,600 


2,245 


371 


2,245 


274 


2,242 


12 


2,240 


1,438 


2,235 


1.874 


2,233 


3,387 


2,231 


15,401 


2,221 


826 


2,218 


10,448 


2,215 


900 


2,213 


240 


2,210 


26 


2,208 


6,065 


2,204 


1,087 


2,198 


813 


2,194 


416 


2,187 


63 


2,184 


171 


2,184 


2,808 


2,179 


3,353 


2,177 


1,195 


2,176 


24,194 


2,174 


197 


2,168 



8 

dcg\rinal\appx-x\Tab-c3\nab 



TABLE C-3 

SORTING ALGORITHM OUTPUT FOR EXPANDED DCG MODEL (PRINCIPAL INPATIENT DIAGNOSES ARE IN UPPER CASE) 



EDCG 


EDXG 


LABEL 


FREQUENCY 

124 


MEAN 


2 


139.02 


other organ transplant 


2.167 


2 


51.01 


sickle cell and other hereditary hemolytic anemias 


115 


2.161 


2 


120.04 


other general symptoms 


21,818 


2.161 


2 


61.01 


headaches, including migraine 


5,262 


2.160 


2 


39.01 


divercula of intestine 


7,029 


2.155 


2 


93.04 


retinal disorders 


14,699 


2.150 


2 


104.02 


pulmonary congestion/hypostasis 


744 


2,148 


2 


18.04 


skin cancer, except melanoma 


7,894 


2.146 


2 


133.01 


sprains 


11,570 


2.142 


2 


92.02 


varicose veins 


1,711 


2,138 


2 


65.07 


neuropathy of leg 


1,122 


2,136 


2 


62.02 


Huntington's Disease, other abnormal movement disorders 


512 


2,130 


2 


137.02 


poisoning by specified nonmedicinal substances/injury by certain external causes 


401 


2,129 


2 


59.03 


non-dependent abuse of drugs 


458 


2,127 


2 


94.01 


impacted earwax 


8,258 


2,126 


2 


18.05 


thyroid/endocrine cancer 


85 


2,121 


2 


123.03 


cough 


4,558 


2,119 


2 


131.06 


hand/wrist/Iower arm fracture 


1,966 


2,117 


2 


97.01 


other bronchitis 


17,546 


2,115 


2 


132.06 


open wound of other sites 


3,199 


2,113 


2 


127.02 


fractures of nasal bone 


129 


2,112 


2 


98.02 


influenza 


2,690 


2,103 


2 


5.03 


injury late effects 


203 


2,100 


2 


125.03 


other urinary system symptoms 


3,916 


2,100 


2 


27.07 


other endocrine disorders 


709 


2,099 


2 


113.01 


diseases of female pelvic organs 


1,186 


2,094 


2 


27.10 


vitamin/other nutritional deficiencies 


893 


2,092 


2 


64.01 


epilepsy and other seizure disorders 


2,633 


2,088 


2 


94.05 


other ear disorders 


5,865 


2,084 


2 


143.03 


history of malignant neoplasm 


2,925 


2,080 


2 


137.05 


adverse effects of drugs in therapeutic use 


1,096 


2,079 


2 


5.01 


infection late effects 


107 


2,077 


2 


4.11 


other viral infections 


4,049 


2,072 


2 


49.04 


other acquired limb deformities 


589 


2,071 


2 


93.05 


glaucoma 


18,155 


2,070 


2 


21.05 


neoplasm of uncertain behavior nec/nos 


3,766 


2,069 


1 


7.06 


other cancer of digestive organs/peritoneum 


2 


2,065 


2 


60.08 


behavior disorder 


134 


2,052 


2 


20 


BENIGN NEOPLASMS 


100 


2,049 


2 


95.03 


chronic sinusitis 


5,741 


2,042 


2 


65.03 


root/plexus disorders 


118 


2,038 


2 


132.05 


open wound/injury of lower arm 


4,006 


2,028 


2 


108 


RENAL/URETERAL/BLADDER CALCULUS 


83 


2.027 


2 


20.07 


other benign neoplasms 


3,030 


2,023 


2 


113 


DISEASES OF FEMALE GENITAL ORGANS 


83 


2.022 


2 


69.01 


essential hypertension 


69,214 


2,021 


2 


143.08 


elective surgery 


72 


2.016 


2 


93.06 


cataract/lens replacement 


56,VVV 


2.014 


2 


120.01 


somatic/segmental dysfunction 


4,246 


2,003 


2 


118.02 


psoriasis and similar disorders 


1,331 


2.001 


1 


4.09 


herpes simplex 


32 


1,998 


1 


115.01 


pregnancy/birth complications, mother/child 


59 


1.960 


1 


94 


EAR DISORDERS 


1 


1.752 


1 


4.05 


strep throat/scarlet fever 


30 


1.639 



dcg\final\appx-x\Tab-c3\nab 



TABLE C-3 

SORTI/Mi^ ALGORITHM OUTPUT FOR EXPANDED DCG MODEL (PRINCIPAL INPATIENT DIAGNOSES ARE IN UPPER CASE) 

EDCG EDXG LABEL 



27.05 ovarian dysfunction 
89.02 Raynaud's syndrome 
40.01 hemontioids 

95.01 acute nose/throat infection 

95.02 nasal polyps/allergic rhinitis 
93.09 other eye disorders 

NO CLAIMS IN DATA 

1 1 5.02 pregnancy with abortive outcome 

114.01 genital prolapse 

1 43.02 vaccination, medical exam, other preventive 

94.04 hearing loss 

1 1 8.03 other dermatosis 

95.06 disorders of teeth and jaw 
1 1 8.05 other dermatological disorders 

94.02 otitis media (middle ear infection) 

4.15 mycoses (fungal diseases), miscellaneous 

66.05 other neuropathy 

4.16 other infections 

21 .02 carcinoma in situ of respiratory system 
132.09 foreign body in eye/ear/nose 

89.05 disease of capillaries 

119.02 congenital anomalies of eye 

94.03 vertiginous syndromes 

27.02 thyrotoxicosis 

1 43.05 history of drug allergy/other health hazard 

143.17 screening-'observation/special exams 

20.03 benign neoplasm of skin 
1 1 3.05 menopausal and postmenopausal disorders 

27.01 goiter 

4.08 herpes zoster 

1 34.05 other accidents 

60.01 personality disorders 

27.03 thyroid disorders 

20.04 tienign neoplasm of breast 

93.07 disorders of refraction and accommodation ^e.g., far-, near-sightedness, astigmatism) 

4.03 other intestinal infections 

1 1 5.03 normal pregnancy/delivery 
27.1 1 disorders of lipoid metabolism (high cholesterol) 

1 43.06 family history of disease 

63.02 infantile cerebral palsy 

1 1 3.02 vaginal and cen/ical diseases 

1 37.03 poisoning by other nonmedicinal substances 
1 1 3.03 other diseases of female genital organs 
1 43. 1 6 screening for malignant neoplasm 

90.04 compression of vein 

60. 1 mental retardation 

70.04 secondary hypertension 

115 PREGNANCY/PERINATAL CONDITIONS 

143.15 administrative/consultation 

100.01 specific bacterial pneumonia 

4.04 tulierculosis 
143.11 aftercare 
1 1 9.06 chromosomal anomalies 

65.02 facial nerve disorders 



FREQUENCY 


MEAN 


49 


1.536 


15 


1,484 


147 


1,435 


1,621 


1,414 


346 


1,414 


3,224 


1,371 


74,971 


1,334 


1 


1,293 


137 


1,267 


2,637 


1,264 


294 


1,259 


1,060 


1,175 


133 


1,164 


2,008 


1,153 


380 


1,127 


21 


1,107 


7 


1,088 


108 


1,050 


3 


1,049 


97 


1.036 


18 


1,035 


59 


1,034 


136 


1,023 


72 


1,003 


59 


996 


2,008 


984 


399 


981 


713 


964 


51 


939 


211 


922 


35 


922 


33 


871 


498 


867 


1,594 


M3 


atism) 825 


830 


18 


810 


12 


789 


1,353 


7/7 


96 


743 


64 


■^43 


304 


731 


92 


691 


130 


676 


583 


614 


1 


606 


219 


604 


7 


587 


10 


579 


45 


569 


6 


470 


15 


457 


19 


440 


59 


428 


21 


372 




10 


dcg\final\appx-x\Tab-c3\nab 



TABLE C-3 

SORTING ALGORITHM OUTPUT FOR EXPANDED DCG MODEL (PRINCIPAL INPATIENT DIAGNOSES ARE IN UPPER CASE) 



EDCG EDXG LABEL 



27. 1 6 obesity/localized adiposity 

1 43.07 problems of internal organs/external sites 
60.09 developmental behavioral disorders 

1 32.08 caishing injury 

1 7.01 cancer of the eye 

79.01 heart arrest/shock 

1 43. 1 other orthopedic aftercare 

1 1 8.01 dermatitis due to internal agent 

95 NOSE/ THROAT DISEASES 

6.04 other respiratory/intrathoracic cancer 

1 43.1 3 household/family/other psychosocial circumstances 

1 36.04 early complications of trauma 
114 GENITAL PROLAPSE 

60.03 psychophysiologic disorders 

138.05 misadventure to patient in surgery 

81 .02 acute endo/myocarditis 



FREQUENCY 


MEAN 


41 


316 


10 


252 


15 


202 


5 


166 


5 


155 


10 


148 


4 


144 


8 


139 


1 


137 


6 


133 


3 


101 


7 


99 


3 


85 


9 


61 


1 


1 


1 






NOTE: The sorting algorithm ouput is illustrated in the furthermost right-hand (mean) column 
SOURCE: 1992 (expenditures) and 1991 (diagnoses) Medicare claims 



11 

dcg\final\appx-)(\Tab-c3\nab 



TABLE C-4 

SORTING ALGORITHM OUTPUT FOR EXPANDED DOG MODEL WITH PROCEDURES 
(PRINCIPAL INPATIENT DIAGNOSES ARE IN UPPER CASE) 



EDCGP 



EDXGP 



31 


P5 


31 


P2 


23 


142 


20 


P7 


20 


29 


17 


19 


17 


P3 


17 


12 


14 


105 


14 


105.02 


14 


117 


14 


P4 


14 


7 


14 


96 


14 


P6 


14 


51 


14 


106 


14 


66 


14 


104.03 


14 


29.01 


12 


10 


12 


80 


12 


19.02 


12 


138.02 


12 


106.02 


10 


23 


10 


134.04 


10 


67 


10 


102 


10 


45 


10 


24 


10 


99 


10 


25 


10 


7.01 


10 


102.02 


10 


99.01 


10 


25.01 


10 


89 


10 


56 


10 


2.01 


10 


-10 


10 


89.07 


10 


51.03 


8 


78 


10 


53 


10 


6 


10 


63.04 


10 


101 


8 


29.02 


8 


50 


8 


19.03 


8 


88 


8 


16 


8 


6.02 


8 


104 


8 


10.01 


8 


12.04 


8 


139.09 


8 


84 


8 


24.01 


8 


17 


8 


63 


8 


27.09 


7 


119 


8 


12.02 


8 


122 



LABEL 



tracheostomy 
dialysis 

CHEMOTHERAPY 
venous access port 

END STAGE LIVER DISORDERS 

SECONDARY CANCERS 

gastrostomy 

HODGKIN'S DISEASEA.YMPHOMA/MYELOMA/LEUKEMIA 

RESPIRATORY FAILURBARREST 

respiratory arrest 

CHRONIC ULCER OF SKIN 

enterostomy 

STOMACH/SMALL BOWEULIVER/PANCREAS/ESOPHAGUS CANCER 

EMPHYSEMA/CHRONIC BRONCHITIS 

surgical amputations 

OTHER BLOOD DISEASES 

RENAL FAILURE 

POLYNEUROPATHY 

acute lung edema nos 

end stage liver disorders 

LUNG CANCER 

HEART FAILURE 

secondary cancer of respiratory and digestive systems 

infection/inflammation due to internal device/graft 

acute renal failure 

DIABETES WITH ACUTE COMPLICATIONS 

suicide/self-inflicted injury 

CEREBRAL CYSTS, COMPRESSION, EDEMA, ANOXIC DAMAGE, 

LUNG DISEASES DUE TO EXTERNAL AGENTS 

ARTHROPATHY/BONE INFECTION 

DIABETES WITH CHRONIC COMPLICATIONS 

GRAM-NEGATIVE/STAPHYLOCOCCUS PNEUMONIA 

HYPOGLYCEMIA 

cancer of esophagus 

aspiration pneumonia 

gram-negative/staph pneumonia 

hypoglycemic coma 

PERIPHERAL VASCULAR DISEASE 

MANIC AND DEPRESSIVE DISORDERS 

septicemia/shock 

OTHER URINARY TRACT INFECTIONS 

gangrene 

aplastic anemia 

VENTRICULAR TACHYCARDIA 

SUBSTANCE-RELATED PSYCHOSES 

MOUTH/PHARYNXyLARYNX/OTHER RESPIRATORY CANCER 

paraplegia 

ASTHMA 

esophageal varices 

ANEMIA 

secondary cancer of other site 

ARTERIAL EMBOLISM AND THROMBOSIS 

CANCER OF BLADDERMDNEY/URINARY ORGANS 

cancer of pharynx 

OTHER LUNG DISEASE 

lung cancer 

myeloid leukemia 

aspirator, respirator, other machine dependence 

CEREBROVASCULAR DISEASE 

diabetes witti renal manifestation 

NEOPLASM OF NERVOUS SYSTEM 

OTHER NEUROLOGIC DISORDERS 

proteinolorie malnutrition 

CONGENITAL ANOMALIES 

multiple myeloma 

FEVER 



FREQUENCY 


MEAN 


378 


$42,301 


203 


34.102 


732 


23,412 


477 


21,069 


135 


20,585 


793 


18.429 


1,210 


18,224 


322 


17.863 


1,021 


16.404 


2,038 


15,998 


815 


15.885 


317 


15,842 


329 


15,744 


2,419 


15,618 


636 


15,449 


510 


14,638 


335 


14.534 


134 


14.324 


2.022 


14.190 


600 


14,038 


583 


13,221 


6.057 


12,386 


1,868 


12,319 


1.155 


12,144 


1,306 


12.008 


223 


11.516 


217 


1 1 ,333 


89 


11,276 


527 


11,205 


296 


11,144 


1.S40 


11,065 


958 


10.909 


325 


10,860 


228 


10,807 


1,157 


10,775 


1,614 


10,639 


504 


10,599 


597 


10,432 


2,199 


10,421 


4,478 


10,346 


2.368 


10,287 


1,393 


10,265 


922 


10,133 


333 


10,103 


262 


10,077 


134 


10,076 


586 


10,062 


1,263 


10,014 


214 


9,138 


529 


9,112 


2,793 


9,017 


483 


9,001 


676 


8,941 


381 


8,826 


.94 


8,788 


2,659 


8,709 


269 


8.689 


68 


8,682 


4,124 


8,618 


651 


8,591 


180 


8,518 


293 


8,501 


1.875 


8,463 


78 


8,438 


664 


8,390 


175 


8,325 



1 

dcgtfinal\appx-)t\Tat>-c4\naD 



TABLE C-4 

SORTING ALGORITHM OUTPUT FOR EXPANDED DOG MODEL WITH PROCEDURES 
(PRINCIPAL INPATIENT DIAGNOSES ARE IN UPPER CASE) 



EDCGP EDXGP 



8 


106.03 


8 


104.04 


8 


7.05 


8 


109 


8 


54 


8 


92 


8 


97 


8 


37 


8 


84.03 


8 


86 


8 


140 


8 


7.04 


8 


116 


8 


26 


8 


30 


8 


69 


8 


55 


8 


84.02 


8 


104,01 


7 


136 


7 


57 


7 


44 


7 


51.02 


7 


52 


7 


73 


7 


3.01 


7 


60 


7 


62 


7 


125 


7 


74 


7 


66.04 


6 


PI 


6 


54.01 


6 


93.02 


6 


42 


6 


72.01 


6 


24.02 


6 


68 


6 


19.01 


6 


103 


6 


49 


6 


63.03 


6 


126 


6 


88.01 


6 


131.02 


6 


70 


6 


137 


6 


38 


6 


87.01 


6 


121 


6 


100 


6 


64 


6 


72 


6 


132.07 


6 


126.02 


6 


80.01 


6 


53.02 


6 


53.01 


6 


95.05 


6 


106.04 


6 


138.03 


6 


107 


6 


62.05 


6 


89.06 


6 


143 


6 


138.01 



LABEL 



chronic renal failure 

post trauma/surgery pulmonary insufficiency 

cancer of pancreas 

OTHER RENAUURETERAL DISEASES 

DELIRIUMfl-IALLUCINATIONS 

OTHER CIRCULATORY DISEASE 

OTHER BRONCHITIS 

REGIONAL ENTERITIS 

aphasia (loss of language skills/comprehension) 

ATHEROSCLEROSIS 

REHABILITATION PROCEDURES 

cancer of liver 

DERMATOLOGICAL DISORDERS 

DISORDERS OF FLUID/ELECTROLYTE/ACID BASE BALANCE 

OTHER LIVER DISORDERS 

HYPERTENSION, UNCOMPLICATED 

SCHIZOPHRENIC DISORDERS 

hemiplegia (paralysis of one side of body) 

empyema/abscess of lung 

BURNS/NERVE, SPINAL CORD INJURES 

PARANOIA AND OTHER PSYCHOSES 

CONNECTIVE TISSUE DISEASES 

acquired hemolytic anemia 

DEMENTIA 

OTHER ACUTE ISCHEMIA 

HIV/AIDS (including pneumocytosis) 

OTHER MENTAL DISORDERS 

DEGENERATIVE NEUROLOGIC DISORDERS 

URINARY SYSTEM/ABDOMINAL-PELVIS SYMPTOMS 

ANGINA PECTORIS 

muscular dystrophies 

intubation/mechanical ventilation 

delirium/delusions/hallucinations 

proliferative diabetic retinopathy 

GASTROINTESTINAL HEMORRHAGE 

acute myocardial infarction 

diabetes v^ith other specified complications 

VALVULAR AND RHEUMATIC HEART DISEASE 

secondary cancer of lymph node 

PLEURISY/PNEUMOTHORAX 

OTHER BONE DISORDERS 

quadriplegia 

VERTEBRAL INJURY 

arterial emt)olism and thrombosis (blood clots) 

dislocation of hip 

HYPERTENSION, COMPLICATED 

POISONING/TOXIC EFFECTS 

PERITONITIS/INTESTINAL OBSTRUCTION 

aortic aneurysm 

COMA/ SYNCOPE 

BACTERIAL PNEUMONIA 

EPILEPSY AND OTHER SEIZURE DISORDERS 

ACUTE MYOCARDIAL INFARCTION 

traumatic amputation of limb/hand/foot/toe 

vertebral fracture with spinal cord injury 

heart failure 

drug psychoses 

alcoholic psychoses 

paralysis of vocal cords/larynx 

renal failure, unspecified 

other complications of certain specified medical procedures 

KIDNEY INFECTION 

autonomic nerve disorder 

vascular insufficiency of intestines 

HISTORY OF DISEASE/AFTERCARE/SCREENING 

malfunction of internal orthopedic device/graft 



FREQUENCY 


MEAN 


2.139 


8,312 


538 


8,281 


300 


8,268 


241 


8,250 


283 


8,244 


331 


8,225 


1.727 


8,224 


160 


8.192 


1,245 


8,147 


398 


8,143 


2,320 


8,131 


248 


8,103 


1.375 


8,101 


1,925 


8,090 


173 


8,072 


737 


8,064 


1,349 


8,053 


4,308 


8,017 


447 


8,015 


105 


7,577 


317 


7.567 


379 


7,516 


222 


7,309 


685 


7,302 


4,911 


7,170 


280 


7,161 


417 


7,124 


210 


7,080 


634 


7,049 


1,534 


7,048 


479 


7,007 


868 


6,805 


1,399 


6,738 


1,149 


6,657 


904 


6,638 


3,229 


6,617 


4,880 


6,616 


394 


6.605 


711 


6,559 


190 


6,534 


870 


6,492 


290 


6.476 


384 


6,463 


2,561 


6,403 


273 


6,384 


348 


6,368 


355 


6,362 


1,220 


6,347 


3,941 


6,308 


1,467 


6.298 


3,507 


6,274 


581 


6,269 


2,542 


6,261 


538 


6,245 


373 


6,240 


33,408 


6,227 


315 


6,223 


456 


6,200 


245 


6,200 


1,412 


6,167 


2,998 


6,157 


319 


6,154 


740 


6,149 


489 


6,145 


570 


6,141 


1,081 


6,131 



dcgtfinal\appx-x\Tab-c4\nab 



TABLE C-4 

SORTING ALGORITHM OLITPUT FOR EXPANDED DCG MODEL WITH PROCEDURES 
(PRINCIPAL INPATIENT DIAGNOSES ARE IN UPPER CASE) 



EDCGP 



EDXGP 



6 


117.01 


6 


12.05 


6 


139.06 


6 


138 


6 


111 


6 


12.03 


6 


62.03 


6 


33 


6 


63.05 


6 


78.01 


6 


87.02 


6 


66.02 


6 


19.04 


5 


139.01 


5 


58 


S 


98 


5 


Sa 


5 


9 


5 


18 


5 


75 


5 


120 


5 


81 


5 


59.02 


5 


91 


5 


18.01 


5 


61 


5 


121.01 


5 


65 


5 


83 


5 


30.01 




128.01 




13 




129.01 




32.02 




8 




47 




85 




123.02 




90 




89.03 




136.01 




15.02 




93.01 




71 




62.01 




86.01 




54.02 




16.01 




38.02 




14.01 




28 




67.01 




7.03 




27.12 




106.01 




5.02 




92.03 




84.01 




75.01 




129 




75.02 




119.01 




38.01 




73.01 




7.02 




20.02 



LABEL 



chronic ulcer of skin 

other leukemia 

artificial opening status/attention 

COMPLICATIONS OF MEDICAL PROCEDURES AND CARE 

OTHER URINARY DISORDERS 

lymphoid leukemia 

anterior horn cell disease 

GASTRITIS/OTHER GASTRIC DISORDERS 

Cauda equina syndrome 

ve, . ^c tachycardia 

other aneurysm 

inflammatory/toxic neuropathy 

disseminated cancer 

kidney, hej, t, heart valve (humaa_ _, tissue), lung, liver transplant 

NEUROTIC DISORDERS 

VIRAL PNEUMONIA/INFLUENZA 

SUBSTANCE ABUSE AND DEPENDENCE 

RECTAL CANCER 

OTHER CANCER 

PULMONARY HEART DISEASE 

GENERAL SYMPTOMS 

OTHER CARDIAC DISEASE 

drug dependence 

HYPOTENSION (LOW BLOOD PRESSURE) 

cancer of bone and articular cartilage 

HEADACHES 

coma 

MONONEUROPATHY 

PRECEREBRAL ARTERIAL OCCLUSION 

cirrhosis 

pelvic fracture 

CANCER OF UTERUS/CERVIX/FEMALE GENITAL ORGANS 

femoral fracture 

ulcer with perforation 

COLON CANCER 

BACK PAIN 

TRANSIENT CEREBRAL ISCHEMIA 

hemoptysis (coughing up blood) 

THROMBOPHLEBITIS 

peripheral vascular disease 

third degree burns 

cancer of testis/male genital organs 

diabetic retinopathy 

MYOCARDIAL INFARCTION 

Parkinson's disease 

atherosclerosis of major vessel 

hallucinations, symptomatic 

cancer of bladder/kidney/urinary organs 

peritonitis 

cancer of ovaries/placenta/uterino adnexia 

PANCREATITIS/ OTHER PANCREATIC DISORDERS 

cerebral cysts, compression, edema, anoxic damage, other brain conditions 

cancer of small bowel 

disorders of plasma protein metatx>lism 

nephritis, dialysis encounter 

cerebrovascular disease late effects 

other circulatory disease/postphlebitic syndrome 

cerebrovascular accident (stroke) 

pulmonary emtiolism (blood clot) 

FEMORAL FRACTURE 

other pulmonary heart disease 

spina bifida, other congenital anomalies of nervous system 

intestinal obstruction 

other acute ischemia 

cancer of stomach 

benign neoplasm of respiratory system 



FREQUENCY 


MEAN 


10.017 


6,119 


519 


6,110 


1,232 


6,103 


1,987 


6,097 


366 


6,089 


947 


6,087 


226 


6,070 


964 


6,065 


1,768 


6.026 


1,862 


6.025 


1.006 


6,010 


1,483 


6,005 


577 


6,004 


133 


5,536 


145 


5,535 


134 


5.425 


315 


5,347 


125 


5.268 


91 


5.236 


121 


5.181 


283 


5,175 


69 


5,161 


261 


5,146 


142 


5.124 


403 


5,121 


90 


5,102 


609 


5.047 


87 


5,044 


571 


5,040 


732 


5.025 


932 


4,946 


178 


4.850 


4,067 


4,849 


378 


4,824 


323 


4.817 


1,415 


4.785 


899 


4,778 


864 


4,766 


395 


4,761 


10,704 


4,761 


119 


4,758 


164 


4,738 


4,303 


4,730 


939 


4,725 


4,310 


4,705 


6,398 


4,699 


217 


4,683 


2.672 


4,678 


159 


4,673 


471 


4,663 


306 


4,660 


1,265 


4,652 


154 


4,648 


413 


4,645 


579 


4,645 


2,269 


4,645 


1,978 


4,643 


12,352 


4,643 


590 


4,641 


1,511 


4,641 


1,602 


4,635 


389 


4,634 


2.844 


4,633 


4,499 


4,626 


212 


4,609 


378 


4,609 



d cg\f ina l\a ppx-xMa b-c4\n a b 



TABLE C-4 

SORTING ALGORITHM OUTPUT FOR EXPANDED DCG MODEL WITH PROCEDURES 
(PRINCIPAL INPATIENT DIAGNOSES ARE IN UPPER CASE) 



EDCGP EDXGP 





6.01 




82 




71.02 




68.03 




43 




134 




89.04 




105.01 




63.08 




31 




28.02 




71.01 




77 




24.03 




139.04 




12.01 




119.03 




15.01 




52.01 




66.01 




139.03 




21.01 




15 




9.01 




32 




143.14 




18.02 




20.05 




139.07 




76 




17.03 




41.02 




68,01 




106.05 




128 




81.01 




39 




125.01 




74.01 




83.01 




139.05 




51.04 




116.02 




51.05 




27.04 




37.01 




56.01 




52.02 




81.04 




28.01 




85.01 




126.01 




17.02 




82.01 




134.03 




52.03 




57.02 




121.02 




21.04 




33.01 




4 




77.01 




81.03 




18.06 




68.02 




96.01 



LABEL 



cancer of mouth/tongue 

CEREBRAL HEMORRHAGE 

old myocardial Infarction 

mitraiyaortc valve disorders 

GOUT/ARTHROPATHY/DERANGEMENTS 

CONTUSIONS/ACCIDENTS/INJURY, SUPERFICIAL AND NOS 

other arterial disease 

respiratory failure 

other central nervous system disorders 

DISEASES OF ESOPHAGUS 

chronic pancreatitis/other pancreatic diseases 

myocardial infarction 

ATRIAL ARRYTHMIA 

diabetes with unspecified complications 

join* replacement 

lymphoma/Karposi's sarcoma/Hodgkin's Disease 

congenital anomalies of cardiac/circulatory systems 

prostate cancer 

senile/presenile psychoses 

peripheral neuropathy 

heart, heart valve replacement by artificial device 

carcinoma in situ of digestive organs 

CANCER OF PROSTATE/TESTIS/MALE GENITAL ORGANS 

rectal cancer 

ULCERS 

care not delivered 

cancer of connective and other soft tissue 

benign neoplasm of urinary 

postsurgical t '.es, eye 

RHYTHM -ND CONDUCTION DISORDERS 

benign neoplasm brain/nervous systemypituitary, pineal glands 

biliary tract disease 

rheumatic fever/heart disease 

impaired renal function 

PELVIC FRACTURE 

pericarditis, post-MI 

DIVERTICULA OF INTESTINE 

retention of urine 

angina pectoris 

precerebral arterial occlusion 

other organ replacement 

hemophilia and other coagulation defects 

bullous dermatoses 

purpura/thrombocytopathy/hemorrhagic conditions 

adrenal gland disorders 

regional enteritis (Crohn's disease) 

manic and depressive disorders 

other organic psychotic conditions 

cardiomegaly (enlarged heart) 

acute pancreatitis 

transient cerebral ischemia 

vertebral fracture without spinal cord injury 

cancer of the brain/nervous system/pituitary, pineal glands 

cerebral hemorrhage 

accidental falls 

cerebral degeneration/Alzheimer's disease 

other nonorganic psychoses 

syncope (fai'-*'ng) and collapse 

neoplasm of uncertain behavior, specified sites 

pyloric/duodenal obstruction 

OTHER INFECTIOUS AND PARASITIC DISEASES 

atrial arrhythmia 

cardiomyopathy/myocarditis 

other/ill-defined site cancer 

mitral or aortic valve/endocardia disease 

emphysema/chronic bronchitis 



FREQUENCY 


MEAN 


411 


4,608 


107 


4,607 


3,449 


4,602 


1,690 


4,601 


211 


4,600 


242 


4,598 


2,164 


4,584 


4,344 


4,568 


407 


4,552 


457 


4,550 


1,044 


4,547 


2,915 


4,528 


908 


4,513 


5,009 


4,494 


2.281 


4,491 


1,226 


4,480 


3.130 


4,477 


7,860 


4,474 


5,528 


4,453 


2,178 


4,441 


707 


4,438 


575 


4,425 


841 


4,420 


2,123 


4,408 


873 


4,403 


704 


4,403 


429 


4.402 


392 


4,401 


128 


4,399 


910 


4,392 


744 


4,388 


496 


4,386 


1,107 


4.385 


409 


4,376 


223 


4.371 


546. 


4,337 


879 


4,331 


3,011 


4,331 


18,698 


4,330 


5,977 


4,328 


157 


4,328 


1,885 


4.325 


358 


4,324 


1,111 


4,323 


491 


4,320 


683 


4,311 


5,315 


4,310 


830 


4,307 


5,843 


4,306 


933 


4,302 


7,346 


4,296 


2,116 


4,292 


723 


4,280 


837 


4,278 


4,290 


4,267 


4,763 


4,260 


3,825 


4,260 


7,283 


4.257 


2,698 


4,251 


186 


4,233 


471 


4,191 


12,779 


4,188 


2,345 


4,187 


2,970 


4,173 


11,084 


4,168 


33,471 


4,162 



dcgXflna f\appx-x\Ta b-c4\nab 



TABLE C-4 

SORTING ALGORITHM OUTPUT FOR EXPANDED DOG MODEL WITH PROCEDURES 
(PRINCIPAL INPATIENT DIAGNOSES ARE IN UPPER CASE) 



EDCGP 



EDXGP 



4 


140.01 


4 


131.05 


4 


81.05 


4 


89.01 


4 


143.09 


4 


123.01 


4 


8.01 


4 


109.02 


4 


90.02 


4 


46 


4 


-23 


4 


102.03 


4 


40.03 


4 


133 


4 


62.06 


4 


124 


4 


52.04 


4 


6.03 


4 


4.07 


4 


62.04 


4 


44.01 


4 


26.01 


4 


103.01 


4 


23.01 


4 


66.03 


4 


139.08 


4 


63.07 


4 


131 


4 


60.06 


4 


132.01 


4 


142.01 


4 


102.01 


4 


4.14 


4 


91.01 


4 


132.03 


4 


125.02 


4 


143.12 


4 


71.03 


4 


34.01 


4 


63.06 


4 


; 


4 


44.02 


4 


118.04 


4 


139 


2 


98.01 


2 


70.05 


2 


48 


2 


131.01 


2 


59.01 


2 


70.03 


2 


119.04 


2 


45.02 


2 


135.01 


2 


27.15 


2 


134.01 


2 


131.03 


2 


38.03 


2 


93.03 


2 


93 


2 


55.01 


2 


136.03 


1 


27 


2 


60.07 


2 


70.02 


2 


141.01 


2 


45.01 



LABEL 



rehabilitation procedures 

fracture of rib, closed 

other heart disease 

specified peripheral vascular disease 

prothesis/other device fitting, adjustment 

dyspnea (labored breathing)/other resp abnormalities 

colon cancer 

hydronephrosis/other renal/urethral disorders 

noninfectious lymphatic disorders 

OSTEOARTHRITIS 

RESPIRATORY/OTHER CHEST SYMPTOMS 

respiratory conditions due to other external agents/postinflammatory fibrosis 

intestinal abcess/ulceration/perforafon 

SPRAINS 

Tay-Sachs. other hereditary and degenerative central ner ous system diseases 

CARDIOVASCULAR SYMPTOMS 

senility without psychosis 

cancer of larynx 

bacterial infection in other diseases 

other spinal cord disease 

systemic lupus erythematosus and other connective tissue disease 

disorders of fluid/electrolyfe/acid-base balance 

pleurisy/pneumothorax 

diabetes with acute complications 

myoneural disorders/myasthenia gravis 

other postsurgical states, including dialysis status 

nervous/musculoskeletal system symptoms 

FRACTURE/DISLOCATION 

nonpsychotic organic brain syndrome 

foreign body in pharynx/larynx 

chemotherapy 

bronchiectasis, lung diseases due to specified external agent 

thrush 

hypotension (low blood pressure) 

gi/liver/kidney/spleen/pelvis injury 

incontinence/urethral discharge 

donor 

other chronic ischemic heart disease 

appendicitis 

other paralytic disorders 

ANAURECTAUGASTROINTESTINAL DISORDERS 

rheumatoid arthritis and other inflammatory polyarthropafhy 

diseases of nail 

ORGAN REPLACEMENT/TRANSPLANT/POST-SURGICAL STATES 

viral pneumonia 

hypertension encephalopathy 

DISORDERS OF SOFT TISSUES 

shoulder dislocation 

alcohol dependence 

hypertensive heart and renal disease 

congenital anomalies of musculoskeletal/limb 

osteomyelitis 

Intracranial injury 

other hyperalimentation 

concussion 

dislocation of knee 

other peritoneal disorders 

endophthalmitis (eye inflammation) 

DISORDERS OF THE EYE AND ADNEXA 

schizophrenic disorders 

nerve Injury 

OTHER ENDOCRINE/NUTRITIONAUMETABOLIC DISEASES 

depression, not elsewhere classified 

malignant hypertensive heart disease 

radiation therapy 

arthropathy with infection 



FREQUENCY 


MEAN 


2,861 


4,160 


2,423 


4,160 


5,650 


4.159 


961 


4,155 


716 


4,151 


18,621 


4,143 


2,729 


4,143 


4.709 


4.140 


597 


4,140 


2.055 


4,140 


138 


4.135 


2,478 


4.126 


1,231 


4,125 


389 


4,121 


292 


4.116 


1,477 


4,115 


597 


4,112 


463 


4,110 


1,828 


4,110 


447 


4,108 


2.721 


4,106 


10.971 


4.106 


2,669 


4,103 


993 


4,100 


267 


4,099 


6,985 


4.086 


3,661 


4,053 


617 


4.080 


2,850 


4,079 


901 


4,077 


539 


4,074 


1.334 


4,071 


386 


4,060 


1.838 


4,058 


481 


4,057 


3.466 


4,054 


166 


4,049 


58,508 


4.030 


396 


4,025 


342 


4,023 


712 


4,023 


8,435 


4,015 


21,071 


4,011 


50 


4,000 


167 


3,227 


74 


3.092 


74 


3,071 


195 


2,981 


247 


2,968 


219 


2,958 


1,073 


2,933 


33S 


2,928 


478 


2,927 


4'^-y 


2,916 


126 


2,833 


763 


2,758 


111 


2,755 


94 


2,726 


154 


2,725 


2.611 


2,724 


321 


2,712 


1 


2,710 


1.777 


2,660 


560 


2,656 


201 


2,652 


163 


2,630 



dcgVinal\3ppx-x\Tat>-c4\nab 



TABLE C-4 

SORTING ALGORITHM OUTPUT FOR EXPANDED DCG MODEL WITH PROCEDURES 
(PRINCIPAL INPATIENT DIAGNOSES ARE IN UPPER CASE) 



EDCGP 



EDXGP 



LABEL 



2 


22.01 


2 


51.07 


2 


104.05 


2 


109.01 


2 


41.01 


2 


51.08 


2 


11 


2 


49.01 


2 


100.02 


2 


18.03 


2 


65.05 


2 


107.01 


2 


27.06 


2 


63.01 


2 


21.03 


2 


4.10 


2 


86.02 


2 


46.01 


2 


51.01 


2 


131.07 


2 


93.08 


2 


65.04 


2 


49.02 


2 


4.13 


2 


95.08 


2 


50.01 


2 


43.02 


2 


4.01 


2 


35.01 


2 


37.02 


2 


125.04 


2 


60.11 


2 


13.02 


2 


116.01 


2 


111.01 


2 


119.05 


2 


60.02 


2 


92.01 


2 


76.01 


2 


57.01 


2 


123.04 


2 


11.01 


2 


60.05 


2 


25.02 


2 


127.01 


2 


41.03 


2 


92.04 


2 


69.02 


2 


44.04 


2 


124.01 


2 


42.01 


2 


76.02 


2 


70.01 


2 


138.04 


2 


143.04 


2 


112.01 


2 


27.13 


2 


47.01 


2 


113.04 


2 


101.01 


2 


136.02 


2 


44.03 


2 


139.02 


2 


60.04 


2 


4.06 


2 


33.02 



diabetes without complications 

Immune disorders 

other lung disease 

urethral stricture 

cholelithiasis (gallstones) 

other blood disease 

BREAST CANCER 

osteoporosis 

other pneumonia 

melanoma 

other cranial nerve disorders 

kidney infection 

testicular dysfunction 

multiple sclerosis, other central nervous system dymelinat'on 

carcinoma in situ of other sites 

viral hepatitis 

atherosclerosis/general, ascvd 

osteoarthrosis 

sicWe cell and other hereditary hemolytic anemias 

other fractures 

vitreous hemorrhage 

root/plexus lesions 

other bone disorders (e.g., curvature of spine, Pagefs disease) 

dermatophytosis (fungal skin infections, e.g., athlete's foot) 

salivary gland diseases 

iron deficiency and other anemias 

other arthropathy/joint disorders, derangements 

bacterial enteritis (intestinal infections) 

abdominal hernia, complicated 

ulcerative colitis 

abdominal/pelvis symptoms 

other mental disorders 

cancer of cervix/female genital organs 

cellulitis/abscess/other local skin infection 

other urinary disorders 

congenital anomalies of skin 

sexual deviations and disorders 

superficial phlebitis-leg 

conduction disorders/cardiac dysrhythmias 

paranoid states 

respiratory/other chest symptoms 

breast cancer 

adjustment reaction 

other hypoglycemia 

fractures of skull/face 

other gallbladder disorders 

other specified circulatory disorders 

hypertensive heart disease 

polymyalgia rheumatica 

chest pain 

gastrointestinal hemorrhage 

premature heart beats 

malignant hypertension 

other complications of medical and surgical procedures, nee, (e.g., post-operative infection) 

history of mental disorder/other disease 

hyperplasia of prostate 

disorders of mineral metabolism 

back disorders (e.g., slipped disk, lumbago, sciatica, backache) 

female stress incontinence 

asthma 

other bums 

inflammatory spondylopathies 

other organ transplant 

acute reaction to stress 

other bacterial Infections 

gastritis/other gastric disorder (stomach disorders) 



FREQUENCY 


MEAN 


18,446 


2,630 


123 


2.597 


2,033 


2,589 


951 


2.587 


1,048 


2,583 


851 


2,576 


220 


2,566 


2,619 


2,564 


2,874 


2.560 


339 


2,540 


57 


2,538 


435 


2,534 


114 


2,530 


363 


2,525 


866 


2,522 


90 


2,520 


4.213 


2.511 


27,676 


2,508 


121 


2,487 


1,610 


2,486 


274 


2,485 


180 


2.479 


3,419 


2,472 


7,055 


2,461 


408 


2,454 


7,520 


2,454 


24,228 


2,445 


72 


2,445 


192 


2,444 


284 


2,439 


14,744 


2,434 


276 


2,434 


315 


2.413 


6,799 


2,413 


4,175 


2,411 


616 


2,398 


395 


2,389 


255 


2,384 


6,176 


2.382 


79 


2,375 


3,588 


2,371 


3,531 


2,370 


614 


2.354 


448 


2,363 


178 


2,361 


1,333 


2,357 


797 


2,356 


4,478 


2,353 


698 


2,347 


14,015 


2,338 


3,040 


2,337 


1,249 


2,336 


4,696 


2,334 


915 


2,330 


711 


2,329 


10,057 


2,328 


502 


2,325 


23,584 


2,324 


685 


2,317 


3,410 


2,316 


481 


2,315 


449 


2,315 


129 


2,313 


323 


2,312 


246 


2,310 


14,974 


2,306 



6 

dcg\fJnal\appx-)c\Ta b-c4\nab 



TABLE C-4 



SORTING ALGORITHM OUTPUT FOR EXPANDED DCG MODEL WITH PROCEDURES 
(PRINCIPAL INPATIENT DIAGNOSES ARE IN UPPER CASE) 



EDCGP 



EDXGP 



LABEL 



2 


32.01 


2 


65.06 


2 


40.04 


2 


137.04 


2 


90.01 


2 


36.01 


1 


20.06 


2 


36 


2 


21.06 


2 


120.03 


2 


31.01 


2 


40.02 


2 


95.04 


2 


58.01 


2 


27.08 


2 


20.01 


2 


30.C2 


2 


112.03 


2 


43.01 


2 


49.03 


2 


112.02 


2 


130.01 


2 


95.07 


2 


110.01 


2 


104.02 


1 


1.01 


2 


13.01 


2 


134.02 


2 


119.07 


2 


65.01 


2 


95.09 


2 


120.02 


2 


113 


2 


122.01 


2 


4.02 


2 


65.03 


2 


62.02 


1 


27.14 


2 


48.01 


2 


61.01 


2 


120.04 


2 


108.01 


2 


92.02 


1 


131.04 


2 


137.02 


2 


39.01 


2 


124.02 


2 


133.01 


2 


93.04 


2 


18.04 


2 


97.01 


2 


132.04 


2 


65.07 


2 


59.03 


2 


27.10 


2 


98.02 


2 


132.06 


2 


143.03 


2 


113.01 


2 


94.01 


2 


132.02 


2 


143.01 


2 


123.03 


2 


131.06 


2 


125.03 


2 


51.06 



ulcer without perforation 

neuropathy of upper limb (e.g., carpal tunnel syndrome) 

other intestinal disorders 

allergy, unspecified 

phlebitis and thrombophlebitis 

abdominal hernia/uncomplicated 

tienign neoplasm of eye 

ABDOMINAL HERNIA/ UNCOMPLICATED 

unspecified neoplasm 

n-^'aise and fatigue 

disease of esophagus 

anal/rectal disorders 

larynxA/ocal cord diseases 

neurotic disorders (e.g. anxiety, f" "' " -tack, phobias) 

miscellaneous endocrine disorders 

benign neoplasm of digestive system 

other liver disorders 

penis/testis/male genital organs disorders 

nout/crystal arthropathy 

flat foot, acquired deformities of toe 

other prostatic disorders 

fractures of lower limb 

other diseases of upper respiratory system 

cystitis, other urinary tract infections 

pulmonary congestion/hypostasis 

central nervous system infection (e.g., meningitis) 

cancer of uterus 

contusion/superficial injury 

other congenital anomalies 

trigeminal nerve disorder 

oral soft tissue/tongue/jaw disorders 

dizziness and giddiness 

DISEASES OF FEMALE GENITAL ORGANS 

fever 

viral enteritis (intestinal infections) 

root/plexus disorders 

Huntington's Disease, other abnormal movement disorders 

cystic fibrosis, metabolism disorders, nec/nos 

disorders of soft tissue 

headaches. Including migraine 

other general symptoms 

renal/ureteral/bladder calculus (e.g., kidney stones) 

varicose veins 

other dislocations 

poisoning by specified nonmediclnal substances/injury by certain external causes 

divercula of intestine 

other cardiovascular symptoms 

sprains 

retinal disorders 

skin cancer, except melanoma 

other bronchitis 

open wound of eye 

neuropathy of leg 

non-dependent abuse of drugs 

vitamin/other nutritional deficiencies 

influenza 

open wound of other sites 

history of malignant neoplasm 

diseases of female pelvic organs 

impacted earwax 

heart/lung/blood vessels injury 

infectious disease contact/carrier 

cough 

hand/wrist/lower arm fracture 

other urinary system symptoms 

white blood cell disorders 



FREQUENCY 


MEAN 


3,226 


2,305 


1,565 


2,300 


4,937 


2,296 


1,482 


2.296 


1,105 


2,296 


5,444 


2,291 


22 


2,289 


193 


2,287 


3.356 


2,286 


6,230 


2,284 


4,554 


2,280 


4,531 


2,276 


319 


2,276 


5,495 


2,272 


390 


2,272 


3,697 


2,269 


871 


2,262 


1.916 


2.260 


3,149 


2,253 


2,650 


2.252 


3,463 


2.251 


1,917 


2.249 


2,905 


2.248 


15,771 


2.248 


779 


2,241 


12 


2,240 


428 


2,238 


10,687 


2.238 


927 


2,236 


296 


2,234 


1,120 


2.231 


6,184 


2,223 


91 


2,219 


858 


2,216 


381 


2,216 


120 


2,212 


521 


2,210 


26 


2,208 


24,722 


2,191 


5,394 


2,184 


22,457 


2,183 


1,229 


2,176 


1,744 


2,174 


267 


2.173 


420 


2,171 


7,200 


2,171 


3,433 


2,168 


11,805 


2,160 


14,944 


2,158 


8,030 


2,153 


18,130 


2,150 


177 


2,149 


1,148 


2,143 


467 


2,141 


925 


2,138 


2,785 


2,137 


3,267 


2,134 


2,^94 


2,134 


1,232 


2,132 


8,409 


2,131 


67 


2,130 


201 


2,129 


4,763 


2,126 


2,001 


2,125 


4,033 


2,122 


354 


2,117 



dcg\final\appx-x\TatM:4\nab 



TABLE C-4 

SORTING ALGORITHM OUTPUT FOR EXPANDED DOG MODEL WITH PROCEDURES 
(PRINCIPAL INPATIENT DIAGNOSES ARE IN UPPER CASE) 



EDCGP 


EDXGP 
94.05 


LABEL 


FREQUENCY 


MEAN 


2 


other ear disorders 


6,005 


2,115 


2 


127.02 


fractures of nasal bone 


131 


2,115 


2 


27.07 


other endocrine disorders 


728 


2,106 


2 


64.01 


epilepsy and other seizure disorders 


2,725 


2,105 


2 


137.05 


adverse effects of dnjgs in therapeutic use 


1,152 


2,102 


2 


93.05 


glaucoma 


18,478 


2,086 


2 


49.04 


other acquired limb deformities 


602 


2,085 


2 


5.03 


injury late effects 


208 


2,084 


2 


21.05 


neoplasm of uncertain behavior nec/nos 


3,872 


2,084 


2 


143.10 


other orthopedic aftercare 


275 


2,082 


2 


4.11 


other viral infections 


4,150 


2,073 


2 


137.01 


poisoning by prescription or over-the-counter medication's 


307 


2,072 


1 


7.06 


other cancer of digestive organs/peritoneum 


2 


2,065 


2 


18.05 


thyroid/endocrine cancer 


88 


2,063 


2 


95.03 


chronic sinusitis 


5,927 


2,062 


2 


60.08 


behavior disorder 


136 


2,056 


2 


118.02 


psoriasis and similar disorders 


1,365 


2.042 


2 


20.07 


other benign neoplasms 


3,116 


2.037 


2 


132.09 


foreign body in eye/ear/nose 


890 


2,030 


2 


69.01 


essential hypertension 


70,511 


2.030 


2 


132.05 


open wound/injury of lower arm 


4.094 


2,029 


2 


93,06 


cataract/lens replacement 


57,176 


2.028 


2 


95.02 


nasal polyps/allergic rhinitis 


7,175 


2,010 


2 


120.01 


somatic/segmental dysfunction 


4,330 


2.009 


2 


143.08 


elective surgery 


73 


2,008 


2 


5.01 


infection late effects 


111 


2.006 




4.09 


herpes simplex 


32 


1,998 




115.01 


pregnancy/birth complications, mother/child 


58 


1,994 




94 


EAR DISOROERS 


1 


1,752 




4.05 


strep throat/scarlet fever 


28 


1,737 




89.02 


Raynaud's syndrome 


14 


1,590 




40.01 


hemorrhoids 


141 


1,470 




95.01 


acute nose/throat infection 


1,555 


1,379 




93.09 


other eye disorders 


3.163 


1,378 







NO CLAIMS IN ANY DATA 


74,969 


1,334 




115.02 


pregnancy with abortive outcome 


1 


1,293 




94.04 


hearing loss 


287 


1,286 




143.02 


vaccination, medical exam, other preventive 


2,602 


1.266 




114.01 


genital prolapse 


133 


1,258 




118.03 


other dermatosis 


1,039 


1,189 




95.06 


disorders of teeth and jaw 


131 


1,168 




118.05 


other dermatological disorders 


1.976 


1,156 




4.15 


mycoses (fungal diseases), miscellaneous 


21 


1,107 




94.02 


otitis media (middle ear infection) 


365 


1,098 




66.05 


other neuropathy 


7 


1,088 




134.05 


other accidents 


29 


1,087 




4.16 


other infections 


105 


1,077 




119.02 


congenital anomalies of eye 


57 


1,053 




21.02 


carcinoma in situ of respiratory system 


3 


1,049 




94.03 


vertiginous syndromes 


133 


1,046 




89.05 


disease of capillaries 


18 


1,035 




143.05 


history of dnjg allergy/other health hazard 


58 


991 




27.02 


thyrotoxicosis 


71 


988 




143.17 


screening/observation/special exams 


1.964 


986 




20.03 


benign neoplasm of skin 


393 


972 




27.05 


ovarian dysfunction 


47 


938 




4.08 


herpes zoster 


209 


931 




27.01 


goiter 


50 


917 




113.05 


menopausal and postmenopausal disorders 


692 


906 




27.03 


thyroid disorders 


488 


872 




60.01 


personality disorders 


33 


871 




93.07 


disorders of refraction and accommodation (e.g., far-, near-sightedness, astigmatism) 


813 


828 




4.03 


other intestinal infections 


18 


810 




20.04 


benign neoplasm of breast 


1.556 


806 




115.03 


normal pregnancy/delivery 


12 


789 




27.11 


disorders of lipoid metabolism (high cholesterol) 


1.313 


768 



8 

dcgtfinaf\appx-x\Ta C>-c4\n a b 



TABLE C-4 

SORTING ALGORITHM OUTPUT FOR EXPANDED DCG MODEL WITH PROCEDURES 
(PRINCIPAL INPATIENT DIAGNOSES ARE IN UPPER CASE) 



EDCGP 



EDXGP 

143.06 

63.02 

113.02 

137.03 

113.03 

90.04 

60.10 

70.04 

143.16 

143.15 

115 

IOL.01 

4.04 

143.11 

119.06 

65.02 

27.16 

143.07 

60.09 

20 

132.08 

79.01 

17.01 

95 

6.04 

118.01 

143.13 

136.04 

114 

60.03 

138.05 

81.02 



LABEL 



farr.lly history of disease 

infantile cerebral palsy 

vaginal and cervical diseases 

poisoning by other nonmedicinal substances 

other diseases of female genital organs 

compression of vein 

mental retardation 

secondary hypertension 

screening for malignant neoplasm 

administrative/consultation 

PREGNANCY/PERINATAL CONDITIONS 
specific bacterial pneumonia 
tuberculosis 
aftercare 

chromosomal anomalies 
facial nerve disorders 
obesity/localized adiposity 
problems of internal organs/external site- 
developmental behavioral disorders 
BENIGN NEOPLASMS 
crushing injury 
heart arrest/shock 
cancer of the eye 
NOSE/ THROAT DISEASES 
other respiratory/intrathoracic cancer 
dermatitis due to internal agent 
household/family/other psychosocial circumstances 
early complications of trauma 
GENITAL PROLAPSE 
psychophysiologic disorders 
misadventure to patient in surgery 
acute endo/myocarditis 



FREQUENCY 


MEAN 


95 


749 


64 


743 


296 


723 


91 


699 


128 


683 


1 


606 


218 


606 


7 


587 


569 


586 


43 


585 


10 


579 


5 


544 


15 


457 


19 


440 


59 


428 


21 


372 


40 


322 


9 


280 


15 


202 


1 


167 


5 


166 


9 


164 


5 


155 


1 


137 


6 


133 


6 


132 


3 


101 


7 


99 


3 


85 


9 


61 


1 


1 


1 






NOTE: The sorting algorahm ouput ts illustrated in the furthermost right-hand (mean) column, 
SOURCE: 1992 (expenditures) and 1991 (diagnoses and procedures) Medicare claims. 



<Jcg\Jinal\appx-x\Tab-c4\hal) 



TABLE C-5 

SORTING ALGORITHM OUTPUT FOR CONCURRENT PRINCIPAL INPATIENT DCG MODEL 



DCG 



PIPDXG 



LABEL 



35 


68 


35 


105 


35 


12 


31 


7 


31 


79 


31 


117 


31 


142 


31 


29 


31 


87 





3 


31 


17 


31 


19 


31 


102 


31 


140 


27 


5 


27 


88 


27 


89 


23 


10 


23 


71 


23 


139 


23 


136 


23 


106 


23 


6 


23 


22 


23 


45 


23 


104 


23 


78 


23 


1 


23 


99 


23 


81 


23 


141 


23 


86 


23 


138 


23 


2 


23 


67 


23 


119 


23 


135 


23 


82 


20 


9 


20 


8 


20 


14 


17 


129 


17 


30 


17 


51 


17 


66 


17 


72 


17 


37 


17 


75 


17 


103 


17 


63 


17 


56 


14 


46 


14 


44 


14 


16 


14 


84 


14 


127 


14 


49 


14 


143 



VALVULAR AND RHEUMATIC HEART DISEASE 

RESPIRATORY FAILURE/ARREST 

HODGKIN'SDISEASEyLYMPHOMA/MYELOMA/LEUKEMIA 

STOMACH/SMALL BOWEL/LIVER/PANCREAS/ESOPHAGUS CANCER 

HEART ARREST/ SHOCK 

CHRONIC ULCER OF SKIN 

CHEMOTHERAPY 

END STAGE LIVER DISORDERS 

ANEURYSM 

HIV/AIDS (INCLUDING PNEUMOCYTOSIS) 

NEOPLASM OF NERVOUS SYSTEM 

SECONDARY CANCERS 

LUNG DISEASES DUE TO EXTERNAL AGENTS 

REHABILITATION PROCEDURES 

LATE EFFECTS 

ARTERIAL EMBOLISM AND THROMBOSIS 

PERIPHERAL VASCULAR DISEASE 

LUNG CANCER 

MYOCARDIAL INFARCTION 

ORGAN REPLACEMENT/TRANSPU^NT/POST-SURGICAL STATES 

BURNS/NERVE, SPINAL CORD INJURES 

RENAL FAILURE 

MOUTH/PHARYNX/LARYNX/OTHER RESPIRATORY CANCER 

DIABETES WITHOUT COMPLICATIONS 

ARTHROPATHY/BONE INFECTION 

OTHER LUNG DISEASE 

VENTRICULAR TACHYCARDIA 

CENTRAL NERVOUS SYSTEM INFECTION (E.G., MENINGITIS) 

GRAM-NEGATIVE/STAPHYLOCOCCUS PNEUMONIA 

OTHER CARDIAC DISEASE 

RADIOTHERAPY 

ATHEROSCLEROSIS 

COMPLICATIONS OF MEDICAL PROCEDURES AND CARE 

SEPTICEMIA/SHOCK 

CEREBRAL CYSTS, COMPRESSION, EDEMA, ANOXIC DAMAGE, 

CONGENITAL ANOMALIES 

INTRACRANIAL INJURY 

CEREBRAL HEMORRHAGE 

RECTAL CANCER 

COLON CANCER 

CANCER OF PLACENTA/OVARY/UTERINE ADNEXIA 

FEMORAL FRACTURE 

OTHER LIVER DISORDERS 

OTHER BLOOD DISEASES 

POLYNEUROPATHY 

ACUTE MYOCARDIAL INFARCTION 

REGIONAL ENTERITIS 

PULMONARY HEART DISEASE 

PLEURISY/PNEUMOTHORAX 

OTHER NEUROLOGIC DISORDERS 

MANIC AND DEPRESSIVE DISORDERS 

OSTEOARTHRITIS 

CONNECTIVE TISSUE DISEASES 

CANCER OF BLADDER/KIDNEY/URINARY ORGANS 

CEREBROVASCULAR DISEASE 

FRACTURES OF SKULL/FACE/NASAL BONE 

OTHER BONE DISORDERS 

HISTORY OF DISEASE/AFTERCARE/SCREENING 



FREQUENCY 


MEAN 


791 


$39,750 


1,746 


37,674 


827 


35,017 


966 


33,474 


282 


32,675 


1,125 


32,587 


843 


32,518 


272 


32,412 


1,016 


32,306 


16 


32,281 


332 


31,675 


2,419 


31 ,665 


1,632 


31,625 


4,269 


31,435 


235 


27,848 


888 


27,190 


1,054 


27,115 


1,400 


26,780 


3,763 


26.309 


507 


26,255 


145 


26.125 


845 


26,022 


261 


25,866 


380 


25,745 


378 


25,491 


568 


25,367 


476 


25,303 


109 


24,785 


1,846 


24,480 


626 


24,445 


81 


24,361 


648 


24,099 


3,729 


24,076 


2,878 


23,842 


157 


23,762 


146 


23,624 


392 


23.206 


900 


23,177 


447 


21,498 


1,199 


21 ,424 


121 


21,248 


4,224 


19,337 


357 


18,754 


515 


18.557 


140 


18,481 


5,186 


18,355 


194 


17,803 


616 


17,646 


515 


17,351 


354 


17,247 


2,284 


17,071 


3,099 


16,194 


433 


16,039 


793 


16,008 


5,009 


15,620 


109 


15,254 


1,227 


15,048 


586 


15,014 



1 

dcg\final\appx-x\Tab-c5\nab 



TABLE C-5 

SORTING ALGORITHM OUTPUT FOR CONCURRENT PRINCIPAL INPATIENT DCG MODEL 



DOG 



PIPDXG 



14 


80 


14 


38 


14 


96 


14 


21 


14 


24 


14 


54 


14 


28 


14 


43 


14 


62 


14 


4 


14 


26 


14 


18 


14 


69 


12 


55 


12 


13 


12 


73 


12 


35 


10 


83 


10 


52 


10 


27 


10 


15 


10 


64 


10 


100 


10 


47 


10 


110 


10 


32 


10 


76 


10 


42 


10 


109 


10 


132 


10 


50 


10 


92 


10 


41 


10 


58 


10 


98 


10 


118 


10 


128 


10 


65 


10 


101 


10 


126 


10 


20 


10 


40 


10 


34 


8 


130 


8 


23 


8 


116 


8 


25 


8 


39 


8 


70 


8 


131 


8 


60 


8 


11 


8 


59 


7 


57 


7 


33 


7 


111 


7 


90 


7 


107 



LABEL 



HEART FAILURE 

PERITONITIS/INTESTINAL OBSTRUCTION 

EMPHYSEMA/CHRONIC BRONCHITIS 

CARCINOMA IN SITU/NEOPLASM OF UNCERTAIN BEHAVIOR 

DIABETES WITH CHRONIC COMPLICATIONS 

DELIRIUM/HALLUCINATIONS 

PANCREATITIS/ OTHER PANCREATIC DISORDERS 

GOUT/ARTHROPATHY/DERANGEMENTS 

DEGENERATIVE NEUROLOGIC DISORDERS 

OTHER INFECTIOUS AND PARASITIC DISEASES 

DISORDERS OF FLUID/ELECTROLYTE/ACID BASE BALANCE 

OTHER CANCER 

HYPERTENSION, UNCOMPLICATED 

SCHIZOPHRENIC DISORDERS 

CANCER OF UTERUS/CEkviX/FEMALE GENITAL ORGANS 

OTHER ACUTE ISCHEMIA 

ABDOMINAL HERNIA/ COMPLICATED 

PRECEREBRAL ARTERIAL OCCLUSION 

DEMENTIA 

OTHER ENDOCRINE/NUTRITIONAL/METABOLIC DISEASES 

CANCER OF PROSTATE/TESTIS/MALE GENITAL ORGANS 

EPILEPSY AND OTHER SEIZURE DISORDERS 

BACTERIAL PNEUMONIA 

BACK PAIN 

OTHER URINARY TRACT INFECTIONS 

ULCERS 

RHYTHM AND CONDUCTION DISORDERS 

'^GASTROINTESTINAL HEMORRHAGE 

OTHER RENAUURETERAL DISEASES 

INTERNAL AND/OR OPEN WOUND 

ANEMIA 

OTHER CIRCULATORY DISEASE 

GALLBLADDER DISORDERS 

NEUROTIC DISORDERS 

VIRAL PNEUMONIA/INFLUENZA 

OTHER DEMATOLOGICAL DISORDERS 

PELVIC FRACTURE 

MONONEUROPATHY 

ASTHMA 

VERTEBRAL INJURY 

BENIGN NEOPLASMS 

ANAL/RECTAL/GASTROINTESTINAL DISORDERS 

APPENDICITIS 

LOWER LIMB FRACTURES 

DIABETES WITH ACUTE COMPLICATIONS 

DERMATOLOGICAL DISORDERS 

HYPOGLYCEMIA 

DIVERTICULA OF INTESTINE 

HYPERTENSION, COMPLICATED 

FRACTURE/DISLOCATION 

OTHER MENTAL DISORDERS 

BREAST CANCER 

SUBSTANCE ABUSE AND DEPENDENCE 

PARANOIA AND OTHER PSYCHOSES 

GASTRITIS/OTHER GASTRIC DISORDERS 

OTHER URINARY DISORDERS 

THROMBOPHLEBITIS 

KIDNEY INFECTION 



FREQUENCY 


MEAN 


7,942 


15,004 


2,102 


14,916 


3,410 


14,884 


403 


14.679 


1,619 


14,492 


350 


14,447 


740 


14,405 


463 


14,402 


360 


14,376 


1,150 


14,321 


3,098 


14,272 


305 


14,266 


1,131 


14,032 


1.325 


12,662 


376 


12599 


4,415 


12,310 


291 


12,113 


1,013 


11.453 


857 


11,315 


471 


1 1 .205 


1,613 


11.118 


788 


10,997 


5,J56 


10,992 


1,961 


10,966 


1,968 


10,755 


1,658 


10,698 


1,972 


10.657 


1,010 


10,652 


202 


10,597 


389 


10,501 


542 


10.456 


306 


10.452 


2,841 


10,386 


217 


10.357 


176 


10.355 


131 


10.264 


412 


10,217 


134 


10,204 


982 


10,175 


399 


10,173 


689 


10,055 


1,300 


10,037 


198 


10,007 


625 


8,972 


189 


8,669 


1,315 


8,597 


239 


8,526 


1,458 


8,320 


417 


8,297 


810 


8,228 


363 


8,052 


1,098 


8,046 


49u 


8,031 


2(W 


7,771 


1,110 


7,730 


298 


7,645 


718 


7,385 


335 


7,336 



c)cg\final\appx-x\Tab-c5\nab 



TABLE C-5 

SORTING ALGORITHM OUTPUT FOR CONCURRENT PRINCIPAL INPATIENT DCG MODEL 



DOG 



PIPDXG 



LABEL 



7 


122 


7 


97 


7 


31 


7 


137 


6 


113 


6 


108 


6 


48 


6 


91 


6 


36 


6 


77 


6 


134 


6 


95 


6 


93 


6 


53 


6 


125 


6 


133 


6 


61 


6 


120 


6 


74 


5 


112 


5 


123 


5 


85 


5 


121 


5 


114 


4 


124 





94 





115 









FEVER 

OTHER BRONCHITIS 

DISEASES OF ESOPHAGUS 

POISONING/TOXIC EFFECTS 

DISEASES OF FEMALE GENITAL ORGANS 

RENAL/URETERAL/BLADDER CALCULUS 

DISORDERS OF SOFT TISSUES 

HYPOTENSION (LOW BLOOD PRESSURE) 

ABDOMINAL HERNIA/ UNCOMPLICATED 

ATRIAL ARRHYTHMIA 

CONTUSIONS/ACCIDENTS/INJURY, SUPERFICIAL AND NOS 

NOSE/ THROAT DISEASES 

DISORDERS OF THE EYE AND ADNEXA 

SUBSTANCE-RELATED PSYCHOSES 

URINARY SYSTEM/ABDOMINA' -°ELVIS SYMPTOMS 

SPRAINS 

HEADACHES 

GENERAL SYMPTOMS 

ANGINA PECTORIS 

PROSTATE/TESTICULAR/PENILt DISORDERS 

RESPIRATORY/OTHER CHEST SYMPTOMS 

TRANSIENT CEREBRAL ISCHEMIA 

COMA/ SYNCOPE 

GENITAL PROLAPSE 

CARDIOVASCULAR SYMPTOMS 

EAR DISORDERS 

PREGMi^NCY/PERINATAL CONDITIONS 

NO 'NPATIENT CLAIMS 



FREQUENCY 


MEAN 


164 


7.234 


766 


7,104 


651 


7,104 


343 


7,045 


497 


6,683 


549 


6,670 


342 


6,530 


269 


6,516 


1,024 


6,488 


1.781 


6,483 


306 


6,354 


329 


6,301 


680 


6,277 


135 


6,227 


511 


6,195 


399 


6,178 


88 


6,176 


373 


6,129 


999 


6.022 


2,255 


5.644 


219 


5,448 


1.310 


5,427 


1,206 


5,382 


948 


5,269 


1.827 


4.218 


306 


3.920 


93 


3.572 


535,521 


816 



NOTE: The sorting algorithm ouput is illustrated in the furthermost right-hand (mean) column. 
SOURCE: 1992 (expenditures) and 1991 (diagnoses and procedures) Medicare claims 



dcg\final\appx-x\Tal>c5\nab 



TABLE C-6 

SORTING ALGORITHM OUTPUT FOR CONCURRENT HOSPITAL AND PHYSICIAN (ALL) DIAGNOSIS DCG MODEL 



ADDCG 


ADDXG 

139.09 


LABEL 


FREQUENCY 
380 


MEAN 


40 


aspirator, respirator, other machine dependence 


$71 ,286 


40 


104.04 


post trauma/surgery pulmonary insufficiency 


1,855 


42,967 


40 


105.02 


respiratory arrest 


4,212 


40,009 


27 


38.02 


peritonitis 


1,058 


28,723 


27 


138.02 


infection/inflammation due to internal device/graft 


1,801 


28,266 


27 


106.02 


acute renal failure 


4,025 


27,627 


23 


102.02 


aspiration pneumonia 


3,016 


25,528 


23 


89.07 


gangrene 


2,912 


23,918 


23 


99.01 


gram-negative/staph pneumonia 


3,154 


23,562 


20 


19.02 


secondary cancer of respiratory and digestive systems 


5,158 


21,565 


20 


-'01 


septicemia/shock 


7,107 


20,144 


17 


104.03 


acute lung edema nos 


1.892 


18,753 


17 


72.01 


acute myocardial infarction 


7,170 


17,871 


17 


131.02 


dislocation of hip 


398 


17,670 


17 


138.05 


misadventure to patient in surgery 


959 


17,400 


14 


134.04 


suicide/self-inflicted injury 


237 


16,517 


14 


27.09 


protein-calorie malnutrition 


3,823 


16,384 


14 


143,12 


donor 


297 


15,759 


14 


138.04 


other complications of medical and surgical procedures nee. (e.g., post-operative infection) 


1 1 ,367 


15,446 


14 


84.03 


aphasia (loss of language skills/comprehension) 


1,760 


i5.aw 


14 


19.01 


secondary cancer of lymph node 


1,612 


15,193 


14 


84.02 


hemiplegia (paralysis of one side of body) 


5.748 


14,944 


14 


140.01 


rehabilitation procedures 


8,831 


14,941 


14 


138.03 


other complications of certain specified medical procedures 


4,569 


14,406 


14 


29.01 


end stage liver disorders 


710 


14,062 


14 


7.05 


cancer of pancreas 


545 


14,062 


10 


53.02 


drug psychoses 


664 


10,999 


10 


59.02 


drug dependence 


692 


10,740 


10 


51.03 


aplastic anemia 


1,180 


10,642 


10 


103.01 


pleurisy/pneumothorax 


8,490 


10,566 


10 


19.03 


secondary cancer of other site 


3,485 


10,471 


10 


54.01 


delirium/delusions/hallucinations 


2,846 


10,207 


10 


12.04 


myeloid leukemia 


389 


10,130 


10 


21.02 


carcinoma in situ of respiratory system 


470 


10,007 


8 


129.01 


femoral fracture 


6,486 


9,198 


8 


139.04 


joint replacement 


3,054 


9,003 


8 


4.07 


bacterial infection in other diseases 


5,026 


8,969 


8 


8'" "5 


vascular insufficiency of intestines 


685 


8,880 


8 


38.03 


other peritoneal disorders 


770 


8,816 


8 


41.02 


biliary tract disease 


800 


8,533 


8 


78.01 


ventric tachycardia 


2,452 


8,426 


8 


121.01 


coma 


1,350 


8,407 


8 


53.01 


alcoholic psychoses 


601 


8,375 


8 


75.01 


pulmonary embolism (blood clot) 


1,422 


8,363 


8 


38.01 


intestinal obstruction 


6,212 


8,121 


8 


60.01 


personality disorders 


1,338 


8,121 


8 


33.01 


pyloric/duodenal obstruction 


407 


8,119 


8 


128.01 


pelvic fracture 


1,600 


8,028 


7 


73.01 


other acute ischemia 


10,902 


7,105 


6 


100.01 


specific bacterial pneumonia 


1,299 


6,745 


6 


139.07 


postsurgical states, eye 


138 


6,378 


6 


63.03 


quadriplegia 


270 


6,348 


6 


82.01 


cerebral hemorrhage 


1,482 


6,281 


6 


141.01 


radiation therapy 


1,805 


6,169 


6 


105.01 


respiratory failure 


7,962 


6,122 


6 


29.02 


esophageal varices 


192 


6,102 


6 


139.06 


artificial opening status/attention 


1,101 


6,087 


5 


28.01 


acute pancreatitis 


963 


5,558 


5 


88.01 


arterial embolism and thromtwsis (blood clots) 


2,437 


5,361 



1 

dcg\final\appx-x\Tab-c6\nab 



TABLE C-6 

SORTING ALGORITHM OUTPUT FOR CONCURRENT HOSPITAL AND PHYSICIAN (ALL) DIAGNOSIS DCG MODEL 



ADDCG 


AODXG 


5 


136.01 


5 


25.01 


5 


125.01 


5 


26.01 


5 


3.01 


5 


7.04 


5 


4.01 


5 


7.02 


4 


57.01 


4 


63.04 


4 


54.02 


4 


63.08 


4 


138.01 


4 


132.07 


4 


142.01 


4 


67.01 


4 


21.01 


4 


59.01 


3 


3401 


3 


68.03 


3 


15.02 


3 


62.04 


3 


132.02 


3 


106.01 


3 


62.05 


3 


63.06 


3 


41.03 


3 


52.02 


3 


7.03 


3 


75.02 


3 


143.14 


3 


143.08 


3 


126.02 


3 


6.04 


3 


139.03 


3 


137.01 


3 


81.04 


3 


10401 


3 


20.05 


3 


79.01 


3 


24.01 


3 


98.01 


3 


66.02 


3 


41.01 


3 


19.04 


3 


10.01 


3 


62.03 


3 


106.03 


3 


90.03 


3 


68.01 


3 


139.08 


3 


56.01 


3 


81.01 


3 


51.02 


3 


21.03 


3 


81.03 


3 


27.12 


3 


10405 


3 


20.02 



LABEL 



third degree burns 

hypoglycemic coma 

retention of urine 

disorders of fluid/electrolyte/acld-base balance 

HIV/AIDS (including pneumocytosis) 

cancer of liver 

bacterial enteritis (Intestinal infections) 

cancer of stomach 

paranoid states 

paraplegia 

hallucinations, symptomatic 

other central nervous system disorders 

malfunction of internal orthopedic device/graft 

traumatic amputation of limb/hand/foot/toe 

chemotherapy 

cerebral cysts, compression, edema, anoxic damage, other brain conditions 

carcinoma in situ of digestive organs 

alcohol dependence 

appendicitis 

mitral/aortic valve disorders 

cancer of testis/male genital organs 

other spinal cord disease 

heart/lung/blood vessels injury 

nephritis, dialysis encounter 

autonomic nerve disorder 

other paralytic disorders 

other gallbladder disorders 

other organic psychotic conditions 

cancer of small bowel 

other pulmonary heart disease 

care not delivered 

elective surgery 

vertebral fracture with spinal cord injury 

other respiratory/intrathoracic cancer 

heart, heart valve replacement by artificial device 

poisoning by prescription or over-the-counter medications 

cardiomegaly (enlarged heart) 

empyema/abscess of lung 

benign neoplasm of urinary 

heart arrest/shock 

diabetes with renal manifestation 

viral pneumonia 

inflammatory/toxic neuropathy 

cholelithiasis (gallstones) 

disseminated cancer 

lung cancer 

anterior horn cell disease 

chronic renal failure 

hemorrhage nos 

rheumatic fever/heart disease 

other postsurgical states. Including dialysis status 

manic and depressive disorders 

pericarditis, post-MI 

acquired hemolytic anemia 

carcinoma in situ of other sites 

cardiomyopathy/myocarditis 

disorders of plasma protein metabolism 

other lung disease 

benign neoplasm of respiratory system 



FREQUENCY 


MEAN 


162 


5,332 


282 


5,271 


3,733 


5,219 


17,771 


5,168 


196 


5,144 


150 


5,098 


442 


5,082 


296 


5,056 


381 


4,469 


270 


4,347 


275 


4,291 


447 


4,201 


322 


4156 


396 


4,145 


751 


4,116 


1,580 


4101 


519 


4,042 


1,059 


4,007 


244 


3,889 


2,379 


3,859 


184 


3,745 


413 


3,715 


305 


3,694 


802 


3,675 


637 


3,633 


369 


3,619 


3,804 


3,618 


1,023 


3,612 


118 


3,581 


2,000 


3,563 


704 


3,563 


166 


3,547 


220 


3,525 


168 


3,512 


1,057 


3,504 


1,343 


3,502 


7,258 


3,497 


209 


3,486 


455 


3,480 


2,025 


3,478 


547 


3,464 


684 


3,453 


1,356 


3,452 


3,223 


3,448 


351 


3,433 


1,451 


3,433 


179 


3,423 


1,369 


3,400 


359 


3,378 


1,444 


3,375 


7,313 


3,372 


6,461 


3,365 


572 


3,334 


194 


3,319 


2,253 


3,315 


3,977 


3,309 


545 


3,303 


7,708 


3,296 


447 


3,269 



dcg\final\appx-x\Tab-c6\nab 



TABLE C-6 

SORTING ALGORITHM OUTPUT FOR CONCURRENT HOSPITAL AND PHYSICIAN (ALL) DIAGNOSIS DCG MODEL 



ADDCG 


ADDXG 


3 


87.02 


3 


91.01 


3 


17.02 


3 


70.05 


3 


122.01 


3 


12.02 


3 


55.01 


3 


132.03 


3 


21.04 


3 


5.02 


3 


18.06 


3 


17.03 


3 


27.04 


3 


143.10 


3 


143.09 


3 


18.01 


3 


121.02 


3 


95.05 


3 


139.05 


3 


6.02 


3 


93.08 


3 


83.01 


3 


40.03 


3 


143.13 


3 


89.04 


3 


126.01 


3 


139.01 


3 


5.03 


3 


12.05 


3 


106.04 


3 


135.01 


3 


127.01 


3 


87.01 


3 


51.04 


3 


24.03 


3 


90.02 


2 


7.01 


2 


63.05 


2 


131.03 


2 


143.07 


2 


63.01 


2 


35.01 


2 


51.07 




66.04 




6.01 




49.04 




131.01 




109.02 




117.01 




15.01 




139.02 




16.01 




93.02 




45.01 




45.02 




5.01 




143.04 




9.01 




119.01 



LABEL FREQUENCY MEAN 



other aneurysm 

hypotension (low blood pressure) 

cancer of the brain/nervous system/pituitary, pineal glands 

hypertension encephalopathy 

fever 

multiple myeloma 

schizophrenic disorders 

gi/liver/kidney/spleen/pelvis injury 

neoplasm of uncertain behavior, specified sites 

cerebrovascular disease late effects 

other/ill-defined site cancer 

benign neoplasm brain/nervous system/pituit&i/, pineal glands 

adrenal gland disorders 

other orth'^pedic aftercare 

prothesis/other device fitting, adjustment 

cancer of bone and articular cartilage 

syncope (fainting) and collapse 

paralysis of vocal cords/larynx 

Ciiier organ replacement 

cancer of pharynx 

vitreous hemorrhage 

precerebral arterial occlusion 

intestinal abcess/ulceration/perforation 

household/family/other psychosocial circumstances 

other arterial disease 

vertebral fracture without spinal cord injury 

kidney, heart, heart valve (human/animal tissue), lung, liver transplant 

injur, late effects 

other leukemia 

renal failure, unspecified 

intracranial injury 

fractures of skull/face 

aortic aneurysm 

hemophilia and other coagulation defects 

diabetes with unspecified complications 

noninfectious lymphatic disorders 

cancer of esophagus 

Cauda equina syndrome 

dislocation of knee 

problems of internal organs/external sites 

multiple sclerosis, other central nervous system dymelinalion 

abdominal hernia, complicated 

immune disorders 

muscular dystrophies 

cancer of mouttVtongue 

other acquired limb deformities 

shoulder dislocation 

hydronephrosis/other renal/urethral disorders 

chronic ulcer of skin 

prostate cancer 

other organ transplant 

cancer of bladder/kidney/urinary organs 

proliferative diabetic retinopathy 

arthropathy with infection 

osteomyelitis 

Infection late effects 

history of mental disorder/other disease 

rectal cancer 

spina bifida, other congenital anomalies of nervous system 



601 


3,262 


2,198 


3,255 


747 


3,237 


471 


3,226 


3,288 


3,225 


395 


3,208 


5,374 


3,188 


326 


3,180 


2,841 


3,171 


3,142 


3,148 


2,111 


3,141 


811 


3,136 


491 


3,132 


788 


3,128 


776 


3,125 


381 


3,125 


8,313 


3.124 


181 


3,118 


140 


3,113 


224 


3,110 


881 


3,110 


7,800 


3,103 


1,125 


3,101 


262 


3,088 


2,653 


3,083 


2,303 


3,081 


186 


3,077 


593 


3,075 


390 


3,069 


1,255 


3,067 


1,913 


3,063 


556 


3,027 


2,810 


3,023 


2,402 


3,021 


6,883 


3,020 


702 


3,017 


62 


2,277 


752 


2,141 


1,273 


2,080 


421 


2,073 


648 


2,043 


385 


2,036 


157 


2,025 


218 


1,9^" 


259 


1,952 


1.272 


1,922 


320 


1,908 


2,963 


1,890 


5.313 


1,888 


5.656 


1,881 


326 


1,849 


1.693 


1,836 


529 


1,829 


336 


1,825 


863 


1,821 


175 


1,812 


1,632 


1,812 


1,198 


1,808 


271 


1,807 




3 


dcg\final\appx-)rtTab-c6\nab 



TABLE C-6 

SORTING ALGORITHM OUTPUT FOR CONCURRENT HOSPITAL AND PHYSICIAN (ALL) DIAGNOSIS DCG MODEL 



ADDCG ADDXG 



LABEL 



8.01 colon cancer 

1 8.02 cancer of connective and other soft tissue 

42.01 gastrointestinal hemorrhage 

17.01 cancer of the eye 

1 02.03 respiratory conditions due to other external agents/postinflammatory fibrosis 

71 .02 old myocardial infarction 
90.01 phlebitis and thrombophlebitis 

1 1 5.03 normal pregnancy/delivery 

123.01 dyspnea (labored breathing)/other resp abnonnalities 

71 .01 myocardial infarction 

1 08.01 renal/ureteral/bladder calculus (e.g., kidney stones) 

100.02 other pneumonia 

1 13.04 female stress incontinence 

1 04.02 pulmcnary congestion/hypostasis 

1 .01 central nervous system infection (e.g., meningitis) 

109.01 urethral stricture 

4.06 other bacterial infections 

12.01 lymphoma/Karposi's sarcoma/Hodgkin's Disease 

84.01 cerebrovascular accident (stroke) 

24.02 diabetes with other specified complications 

32.02 ulcer WAU perforation 
21 .06 unspecifiea neoplasm 

1 1 3.01 diseases of female pelvic organs 

132.01 foreign body in pharynx/larynx 

125.02 incontinence/urethral discharge 

1 1 9.04 congenital anomalies of musculoskeletal/limb 
1 4.01 cancer of ovaries/placenta/uterine adnexia 

92.03 other circulatory disease/postphlebitic syndrome 
20.01 benign neoplasm of digestive system 

80.01 heart failure 

143.11 aftercare 

27. 1 3 disorders of mineral metabolism 

111.01 other urinary disorders 

51.05 purpura/thrombocytopathy/hemorrhagic conditions 

85.01 transient cerebral ischemia 

37.02 ulcerative colitis 

7.06 other cancer of digestive organs/peritoneum 

4.14 thrush 

4.10 viral hepatitis 

134.03 accidental falls 

50.01 iron deficiency and other anemias 

51 .06 white blood cell disorders 

1 1 6.02 bullous dermatoses 

1 37.05 adverse effects of drugs in therapeutic use 

48.02 other bone disorders (e.g., curvature of spine, Paget's disease) 

92.04 other specified circulatory disorders 
11 9.07 other congenital anomalies 

93.03 endophthalmitis (eye inflammation) 

81 .05 other heart disease 
77.01 atrial arrhythmia 

1 1 8.01 dermatitis due to internal agent 

32.01 ulcer without perforation 

63.07 nervous/musculoskeletal system symptorrs 

52.03 cerebral degeneration/Alzheimer's disease 

90.04 compression of vein 
106.05 impaired renal function 

20.07 other benign neoplasms 

57.02 other nonorganic psychoses 
66.01 peripheral neuropathy 



FREQUENCY 


MEAN 


1,589 


1,806 


265 


1,802 


6,783 


1,794 


125 


1,776 


1,299 


1,772 


2,042 


1,767 


3,085 


1,765 


149 


1,758 


12,495 


1,757 


1,543 


1,743 


2,240 


1,738 


6,702 


1,735 


1,653 


1,735 


1,324 


1,73? 


411 


1,732 


1,933 


1,729 


323 


1,700 


858 


1,698 


7,680 


1.695 


2,369 


1.682 


195 


1,681 


6,282 


1,677 


1,725 


1,666 


566 


1.666 


2,574 


1,666 


2,086 


1,665 


254 


1,662 


1,196 


1.6b/ 


7,029 


1,651 


15,041 


1,651 


1,554 


1,646 


1,017 


1,643 


8,982 


1,635 


944 


1,625 


3,806 


1,623 


530 


1,619 


116 


1,611 


302 


1,610 


185 


1,602 


2,450 


1,590 


16,967 


1,585 


866 


1,585 


271 


1,584 


2,919 


1,583 


6,704 


1,581 


2,527 


1,579 


1,805 


1,577 


152 


1,572 


2,764 


1,571 


9,784 


1,566 


508 


1,566 


6,746 


1,566 


2,458 


1,555 


3,269 


1,552 


211 


1,547 


260 


1,547 


5,279 


1,546 


2,756 


1,546 


1,713 


1,541 



dcg\final\appx-x\Tab-c6\nab 



TABLE C-6 

SORTING ALGORITHM OUTPUT FOR CONCURRENT HOSPITAL AND PHYSICIAN (ALL) DIAGNOSIS DCG MODEL 



ADDCG ADDXG LABEL 



68.02 mitral or aortic valve/endocardia disease 

131.07 other fractures 

1 23.04 respiratory/other chest symptoms 

92.02 varicose veins 

65.06 neuropathy of upper limb (e.g., carpal tunnel syndrome) 

1 3.01 cancer of uterus 

28.02 chronic pancreatitis/other pancreatic diseases 

12.03 lymphoid leukemia 
92.01 superficial phlebitis-leg 

36.01 abdominal hernia/uncomplicated 

1 '^.03 history of malignant neoplasm 

65.05 other cranial nerve disorders 

1 32.04 open wound of eye 

66.05 other neuropathy 

123.02 hemoptysis (coughing up blood) 

23.01 diabetes with acute complications 

25.02 other hypoglycemia 

1 30.01 fractures of lower limb 

86.01 atherosclerosis of major vessel 

96.01 emphysema/chronic bronchitis 

52.01 senile/presenile psychoses 

62.06 Tay-Sachs, other hereditary and degenerative central neivous system diseases 

30.02 other liver disorders 
51 .08 other blood disease 

89.01 specified peripheral vascular disease 

1 1 5.01 pregnancy/birth complications, mother/child 

81 .02 acute endo/myocarditis 

76.02 premature heart beats 

70.03 hypertensive heart and renal disease 
27.15 other hyperalimentation 

124.01 chest pain 

74.01 angina pectoris 

134.01 concussion 

4.12 late syphilis, symptomatic 

27.08 miscellaneous endocrine disorders 

101.01 asthma 

65.07 neuropathy of leg 
o^.J5 adjustment reaction 

1 36.04 early complications of trauma 

102.01 bronchiectasis, lung diseases due to specified external agent 

89.03 peripheral vascular disease 

76.01 conduction disorders/cardiac dysrhythmias 

37.01 regional enteritis (Crohn's disease) 

107.01 kidney infection 

62.01 Parkinson's disease 

1 1 4.01 genital prolapse 
49.01 osteoporosis 

137.02 poisoning by specified nonmedicinal substances/injury by certain extemal causes 

127.02 fractures of nasal bone 

51 .01 sickle cell and other hereditary hemolytic anemias 

44.02 rheumatoid arthritis and other inflammatory polyarthropathy 
65.01 trigeminal nerve disorder 

1 1 9.03 congenital anomalies of cardiac/circulatory systems 
60.06 nonpsycholic organic brain syndrome 

1 25.04 abdominal/pelvis symptoms 
1 1 .01 breast cancer 

39.01 divercula of intestine 

31 .01 disease of esophagus 

93.01 diabetic retinopathy 



FREQUENCY 


MEAN 


6,909 


1,537 


2,831 


1,536 


7,436 


1,534 


3,833 


1,525 


2,833 


1.525 


663 


1,520 


482 


1,514 


415 


1,51 *, 


630 


1,512 


10,714 


1,511 


6,711 


1,506 


89 


1,499 


286 


1,499 


279 


1,494 


571 


1,494 


739 


1.490 


900 


1,489 


2,996 


1,487 


5,015 


1,484 


24,895 


1.483 


4,561 


1,481 


170 


1,477 


1,626 


1.475 


1,798 


1.474 


673 


1.472 


1,295 


1,466 


104 


1,464 


3,601 


1,463 


582 


1,463 


176 


1,457 


30,837 


1,454 


12,357 


1,448 


214 


1,446 


82 


1,443 


715 


1,440 


8,720 


1,440 


2,551 


1,435 


1,069 


1,432 


233 


1.432 


877 


1,426 


8,634 


1,424 


16,268 


1.418 


488 


1,415 


796 


1,415 


3,225 


1,414 


3,864 


1,408 


5,988 


1.408 


834 


1,408 


230 


1.407 


246 


1.405 


6,228 


1.395 


575 


1,394 


1,914 


1,389 


1,901 


1.387 


26,231 


1.383 


5,175 


1,382 


13,431 


1,380 


10,259 


1,376 


3,507 


1,368 




5 


dcg\final\appx 


■x\Tab-c6\nab 



TABLE C-6 

SORTING ALGORITHM OUTPUT FOR CONCURRENT HOSPITAL AND PHYSICIAN (ALL) DIAGNOSIS DCG MODEL 



ADDCG ADDXG 



LABEL 



18.05 
40.02 
113.03 
6.03 
4.15 
136.02 
95.04 
59.03 
44.01 
49.03 
21.05 
131.06 
60.11 
136.03 
116.01 
33.02 
120.04 
40.04 
62.02 
118.04 
131.05 
52.04 
86.02 
18.03 
143.15 
124.02 
70.02 
119.02 
13.02 
112.03 
18.04 
60.08 
4.13 
4.16 
65.04 
44.03 
27.16 
112.02 
110.01 
27.10 
60.07 
143.17 
27.01 
60.09 
4.03 
71.03 
65.03 
60.03 
43.02 
47.01 
4.04 
44.04 
125.03 
61.01 
48.01 
40.01 
132.06 
63.02 
95.08 



thyroid/endocrine cancer 

anal/rectal disorders 

other diseases of female genital organs 

cancer of larynx 

mycoses (fungal diseases), miscellaneous 

ottier bums 

larynx/vocal cord diseases 

non-dependent abuse of drugs 

systemic lupus erythematosus and other connective tissue disease 

flat foot, acquired deformities of toe 

neoplasm of uncertain behavior nec/nos 

hand/wrist/lower arm fracture 

other mental disorders 

nerve injury 

cellulitis/abscess/other local skin infection 

gastritis/other gastric disorder (stomach disorders) 

other general symptoms 

other intestinal disorders 

Huntington's Disease, other abnormal movement disorders 

diseases of nail 

fracture of rib, closed 

senility without psychosis 

atherosclerosis/general, ascvd 

melanoma 

administrative/consultation 

other cardiovascular symptoms 

malignant hypertensive heart disease 

congenital anomalies of eye 

cancer of cervix/female genital organs 

penis/testis/male genital organs disorders 

skin cancer, except melanoma 

behavior disorder 

dermatophytosis (fungal skin infections, e.g., athlete's foot) 

other infections 

root/plexus lesions 

inflammatory spondylopathies 

obesity/localized adiposity 

other prostatic disorders 

cystitis, other urinary tract infections 

vitamin/other nutritional deficiencies 

depression, not elsewhere classified 

screening/observation/special exams 

goiter 

developmental behavioral disorders 

other intestinal infections 

other chronic ischemic heart disease 

root/plexus disorders 

psychophysiologic disorders 

other arthropathy/joint disorders, derangements 

tiack disorders (e.g., slipped disk, lumbago, sciatica, backache) 

tuberculosis 

polymyalgia rheumatica 

other urinary system symptoms 

headaches, including migraine 

disorders of soft tissue 

hemorrhoids 

open wound of other sites 

infantile cerebral palsy 

salivary gland diseases 



FREQUENCY 


MEAN 


189 


1,366 


8,363 


1,354 


3,925 


1,344 


235 


1,341 


924 


1,320 


742 


1,320 


715 


1,319 


1.436 


1,318 


1,824 


1,317 


6,980 


1,315 


5,678 


1,314 


3,154 


1,314 


612 


1,313 


478 


1,309 


16,451 


1,307 


29,179 


1,306 


44,028 


1,303 


8.694 


1,301 


1,319 


1,298 


15,528 


1.292 


1,336 


1,289 


432 


1,289 


12,464 


1,288 


625 


1,287 


1,231 


1,286 


8,293 


1,283 


1,180 


1,283 


1.122 


1.282 


386 


1,280 


3,593 


1,273 


12,246 


1,267 


222 


1.261 


21,625 


1,256 


2,987 


1,255 


244 


1,247 


827 


1,246 


3,110 


1,245 


6,960 


1,241 


28,383 


1,240 


1,978 


1,234 


3,752 


1,233 


102,611 


1,233 


1,816 


1,23C 


270 


1,23C 


761 


1,226 


40,322 


1,225 


235 


1,224 


249 


1,223 


45,219 


1,223 


41,034 


1,220 


580 


1,216 


1,588 


1,212 


8,268 


1,204 


9,619 


1,203 


45,256 


1,201 


8,623 


1,199 


5,453 


1,197 


470 


1,192 


701 


1,192 



dcg\final\appx-xMab-c6\nab 



TABLE C-6 

SORTING ALGORITHM OUTPUT FOR CONCURRENT HOSPITAL AND PHYSICIAN (ALL) DIAGNOSIS DCG MODEL 



ADDCG ADDXG LABEL FREQUENCY MEAN 



1 134.02 


contusion/superficial injury 


1 66.03 


.nyoneural dlsorders/myasthenia gravis 


1 65.02 


facial nerve disorders 


1 27.14 


cystic fibrosis, metabolism disorders, nec/nos 


1 115.02 


pregnancy with abortive outcome 


1 120.03 


malaise and fatigue 


1 30.01 


cirrhosis 


1 70.04 


secondary hypertension 


1 64.01 


epilepsy and other seizure disorders 


1 123.03 


COUP*! 


1 46.01 


osteoarthrosis 


1 4.02 


viral enteritis (intestinal infections) 


1 27.02 


thyrotoxicosis 


1 120.02 


dizziness ar.d giddiness 


1 119.05 


congenital anomalies of skin 


1 95.09 


oral soft tissue/tongue/jaw disorders 


1 143.05 


history of drug allergy/other health hazard 


1 4.09 


herpes simplex 


1 58.01 


neurotic disorders (e.g. anxiety, panic attack phobias; 


1 69.02 


hypertensive heart disease 


1 133.01 


sprains 


1 134.05 


other accidents 


1 95.07 


other diseases of upper respiratory system 


1 89.05 


disease of capillaries 


1 112.01 


hyperplasia of prostate 


1 60.02 


se"ual deviations and disorders 


1 93.04 


retinal disorders 


1 93.09 


other eye disorders 


1 20.03 


benign neoplasm of skin 


1 113.02 


vaginal and cervical diseases 


1 22.01 


diabetes w/ithout complications 


1 94.04 


hearing loss 


1 4.11 


other viral infections 


1 93.06 


cataract/lens replacement 


1 118.02 


psoriasis and similar disorders 


1 95.06 


disorders of teeth and jaw 


1 20.06 


benign neoplasm of eye 


1 27.06 


testicular dysfunction 


1 132.05 


open wound/injury of lower am 


1 97.01 


other bronchitis 


1 132.08 


crushing injury 


1 132.09 


foreign body in eye/ear/nose 


1 60.04 


acute reaction to stress 


1 94.03 


vertiginous syndromes 


1 27.03 


thyroid disorders 


1 93.05 


glaucoma 


1 120.01 


somatic/segmental dysfunction 


1 95.02 


nasal polyps/allergic rhinitis 


1 94.05 


other ear disorders 


1 98.02 


influenza 


1 118.05 


other dermatological disorders 


1 95.03 


chronic sinusitis 


1 131.04 


other dislocations 


27.07 


other endocrine disorders 


60.10 


mental retardation 


20.04 


benign neoplasm of breast 


27.11 


disorders of lipoid metabolism (high cholesterol) 


143.02 


vaccination, medical exam, other preventive 


143.16 


screening for malignant neoplasm 



18,916 


1,192 


195 


1,190 


598 


1,190 


664 


1,184 


55 


1,180 


12,968 


1,177 


463 


1,174 


205 


1,171 


4,476 


1,166 


9,903 


1,162 


53,379 


1,158 


675 


1,155 


2,568 


1,153 


12,460 


1,147 


1,297 


1,144 


1,923 


1,140 


2,826 


1,138 


913 


1,135 


10,193 


1,135 


9,828 


1,132 


17,931 


1,131 


2,590 


1,131 


5,323 


1,129 


443 


1,112 


22,666 


1,105 


669 


1,101 


27.568 


1,084 


60,986 


1,075 


9.895 


1,074 


8,094 


1,070 


36,450 


1,064 


8,253 


1,063 


6,236 


1,059 


97,015 


1,050 


2,477 


1,049 


2,151 


1,044 


616 


1,044 


200 


1,042 


6,096 


1,037 


31,860 


1,037 


210 


1,029 


1,247 


1,029 


640 


1,026 


5,111 


1,023 


17,794 


1.023 


30,845 


1,022 


6,162 


1,021 


12,191 


1,020 


10,399 


1.018 


3,178 


1,017 


44,562 


1,016 


9,969 


1,014 


9,651 


1.013 


22 


721 


134 


702 


557 


97 


1,335 


82 


553 


66 


138 


62 




7 


clcg\final\appx 


■x\Tab-cS\nab 



TABLE C-6 

SORTING ALGORITHM OUTPUT FOR CONCURRENT HOSPITAL AND PHYSICIAN (ALL) DIAGNOSIS DCG MODEL 

ADDCG ADDXG LABEL _^^^ 

chromosomal anomalies 

malignant hypertension , 

essential hypertension 
menopausal and postmenopausal disorders 
family history of disease 
gout/crystal arthropathy 
NO CLAIMS IN ANY DATA 
strep throat/scarlet fever 
other dermatosis 

poisoning by other nonmedicinal substances 
allergy, unspecified 

disorders of refraction and accommodation (e.g., far-, near-sightedness, astigmatism) 
otitis media (middle ear infection) 
impact 2d earwax 
acute nose/throat infection 
infectious disease contact/ carrier 
herpes zoster 
Raynaud's syndrome 
27.05 ovarian dysfunction 

NOTE: The sorting algorithm ouput is illustrated in the furthermost right-hand (mean) column 
SOURCE: 1992 (expenditures and diagnoses) Medicare claims. 






119.06 





70.01 





69.01 





113.05 





143.06 





43.01 





0.00 





4.05 





118.03 





137.03 





137.04 





93.07 





94.02 





94.01 





95.01 





143.01 





4.08 





89.02 



FREQUENCY 


MEAN 


41 


61 


314 


60 


5,522 


58 


307 


55 


36 


54 


238 


49 


71,130 


49 


21 


40 


670 


39 


44 


39 


58 


31 


249 


29 


278 


27 


596 


26 


1,264 


23 


19 


21 


167 


19 


6 


15 


18 


10 



8 

dcg\final\appx-)rtTab-c6\nab 



APPENDIX D: 
LIFE-SUSTAINING PROC::DURE DEFINITIONS 



TABLE D-1 

•LIFE-SUSTAINING* PROCEDURES (5-DIGIT NUMBERS ARE CPT-4 CODES) 



P1 EMERGENCY INTUBATION/MECHANICAL VENTILATION 

31500 Intubation, endotracheal, emergency procedure 

94650 Intermittent positive pressure breathing (IPPB) treatment; initial 

94651 subsequent 

94656 Ventilation assist and management; first day 

94657 subsequent days 

P2 DIALYSIS 

90935 hemodialysis with single MD evaluation 

90937 hemodialysis procedure requiring repeated evaluation 

90945 dialysis procedure other than hemodialysis with single MD evaluation 

90947 dialysis procedure other than hemodialysis requiring repeated evaluation 

P3 GASTROSTOMY* 

43750 percutaneous placement of gastrostomy tube 

43760 change of gastrostomy tube 

43830 gastrostomy, temporary 

43832 gastrostomy, permanent, with construction of gastric tube 

P4 ENTEROSTOMY 

44300 enterostomy or cecostomy, tube 

44310 ileostomy or jejunostomy, non-tube 

44312 revision of ileostomy; simple 

44314 complicated 

44316 continent ileostomy 

44320 colostomy or skin level cecostomy 

44322 with multiple biopsies 

44340 revision of colostomy; simple 

44345 complicated 

44346 with repair of paracolostomy hernia 

P5 TRACHEOSTOMY 

31600 Tracheostomy, planned 

31603 Tracheostomy, emergency procedure; transtracheal 

31610 Tracheostomy, fenestration procedure with skin flaps 

P6 AMPUTATIONS 

23900 Interthoracoscapular amputation 

23920 Disarticulation of shoulder; 

24900 Amputation, arm through humerus; with primary closure 

25900 Amputation, forearm, through radius and ulna; 

25927 Transmetacarpal amputation; 

27295 Disarticulation of hip 

27590 Amputation, thigh, through femur 

27591 immediate fitting technique including first cast 

27592 open 
27596 re-amputation 
27598 Disarticulation at knee 

27880 Amputation leg, through tibia and fibula; 

27881 with immediate fitting technique including application of first cast 

27882 open, circular , .^ ,, ,-r^^,, u 



TABLE D-1 

'LIFE-SUSTAINING' PROCEDURES (5-DIGIT NUMBERS ARE CPT-4 CODES) 



27886 re-amputation 

27888 Amputation, ankle 

27889 Ankle disarticulation 
28800 Amputation, foot; midtarsal 
28805 transmetatarsal 

P7 VENOUS ACCESS PORT** 

36495 insertion of intravenous infusion pump or venous access port 

36496 revision of intravenous infusion pump or venous access port 

PS CHEMOTHERAPY 

96400 Chemotherapy administrat'f^n subcutaneous or intramuscular 

96408 Chemotherapy administration, intraveneous; push technique 

96410 Chemotherapy administration, intraveneous; infusion technique, up to 1 hr. 

96412 Chemotherapy administration, intraveneous; infusion technique, 1-8 hrs. 

96414 InfL-sion technique, initiation of prolonged 'fusion 

96420 Chemotherapy administration, intra-arterial; push technique 

96422 Chemotherapy administration, intra-arterial; infusion technique, up to 1 hr. 

96423 Chemotherapy administration, intra-arterial; infusion technique, 1-8 hrs. 
96425 Infusion technique, initiation of prolonged infusion 

96445 Chemotherapy infusion into peritoneal cavity 

96450 Ch3motherapy administration, into CNS 

96520 Refilling and maintenance of portable pump 

P9 MAJOR ORGAN TRANSPLANTS 

33935 heart-lung transplant 

33945 heart transplant 

47135 liver transplant 

40260 kidney transplant 

P10 RADIATION THERAPY 

77261 Therapeutic radiology treatment planning; simple 

77262 Therapeutic radiology treatment planning; intermediate 

77263 Therapeutic radiology treatment planning; complex 
77280 Therapeutic radiology simulation-aided field setting; simple 
77285 Therapeutic radiology simulation-aided field setting; intermediate 
77290 Therapeutic radiology simulation-aided field setting; complex 
77295 by three-dimensional reconstruction of tumor volume 

77299 Unlisted procedure, therapeutic radiology clinical treatment planning 

77300 Basic radiation dosimetry calculation 
77305 Teletherapy, isodose plan; simple 
77310 Teletherapy, isodose plan; intemnediate 
77315 Teletherapy, isodose plan; complex 
77321 Special teletherapy port plan 

77326 Brachytherapy isodose calculation; simple 

77327 Brachytherapy isodose calculation; intermediate 

77328 Brachytherapy isodose calculation; complex 

77331 Special dosimetry 

77332 Treatment devices, design and construction; simple 

77333 Treatment devices, design and construction; intermediate 

77334 Treatment devices, design and constoiction; complex cicg\finai\appx-x\Tab-di\nab 



TABLE D-1 

•LIFE-SUSTAINING' PROCEDURES (5-DIGIT NUMBERS ARE CPT-4 CODES) 



77336 Continuing medical radiation physics consultation 

77370 Special medical radiation physics consultation 

77399 Unlisted procedure, medical radiation physics 

77401 Radiation treatment delivery, superficial and/or ortho voltage 

77402 Radiation treatment delivery, single treatment area, up to 5 MeV 

77403 Radiation treatment delivery, single treatment area, 6-10 MeV 

77404 Radiation treatment delivery, single treatment area, 11-19 MeV 

77406 Radiation treatment delivery, single treatment area, 20 or greater MeV 

77407 Radiation treatment delivery, two separate areas, up to 5 MeV 

77408 Radiation treatment delivery, two separate areas, 6-10 MeV 

77409 Radiation treatment delivery, two separate areas, 11-19 MeV 

7741 1 Radiation treatment delivery, two separate areas, 20 or greater MeV 

77412 Radiation treatment delivery, thicc or more areas, up to 5 MeV 

77413 Radiation treatment delivery, three or more areas, 6-10 MeV 

77414 Radiation treatment delivery, three or more areas, 11-19 MeV 

77416 Radiation treatment delivery, three or more areas, 20 or greater MeV 

77417 Therapeutic radiology port films 

77419 Weekly radiation therapy management; conformal 

77420 Weekly radiation therapy management; simple 
77425 Weekly radiation therapy management; intermediate 

77430 Weekly radiation therapy management; complex 

77431 Radiation therapy management with complete course of therapy 

77432 Stereotactic radiation treatment management 
77470 Special treatment procedure 

77499 Unlisted procedure, therapeutic radiology clinical treatment 

77600 Hyperthermia, externally generated 

77605 Hyperthermia, deep 

7761 Hyperthermia, generated by 5 or fewer interstitial probes 

77615 Hyperthermia, generated by more than 5 interstitial probes 

77620 Hyperthermia generated by intracavitary probes 

77750 Infusion or instillation of radioelement solution 

77761 Intracavitary radioelement application; simple 

77762 Intracavitary radioelement application; intermediate 

77763 Intracavitary radioelement applic^uon; complex 

77776 Interstitial radioelement application; simple 

77777 Interstitial radioelement application; intermediate 

77778 Interstitial radioelement application; complex 

77781 Remote afterloading high intensity brachytherapy, 1-4 source positions 

77782 Remote afterloading high intensity brachytherapy, 5-8 source positions 

77783 Remote afterloading high intensity brachytherapy, 9-12 source positions 

77784 Remote afterloading high intensity brachytherapy, over 12 positions 

77789 Surface application of radioelement 

77790 Supervision, handling, loading of radioelement 
77799 Unlisted procedure, clinical brachytherapy 



* For concurrent models using 1992 data, code 43761 was added. 

** For concurrent models using 1992 data, codes 36530. 36531 , 36533, and 36534 were used. 

3 
SOURCE: 1991 CPT-4 procedure codes. dcg\final\appx-x\Tab-d1\nab 



APPENDIX E: 

DIAGNOSTIC CO^T GROUPS BY 
DIAGNOSTIC CATEGORY (DXGROUP) 



TABLE E-1 

DIAGNOSTIC COST GROUPS BY DIAGNOSTIC CATEGORY, FOR ALTERNATIVE DCG MODELS 



DXG 



LABEL 






1 


1.01 


2 


2.01 


3 


3.01 


4 


4.01 


4.02 


4.03 


4.04 


4.05 


4.06 


4.07 


4.08 


4.09 


4.10 


4.11 


4.12 


4,13 


4.14 


4.15 


4.16 


5 


5.01 


5.02 


5.03 



NO CLAIMS IN ANY DATA 

CENTRAL NERVOUS SYSTEM INFECTION (E.G., MENINGITIS, ENCEPHALITIS) 
central nervous system infection (e.g., meningitis, encephalitis) 

SEPTICEMIA/SHOCK 
septicemia/shock 

HIV/AIDS (INCLUDING PNEUMOCYTOSIS) 
HIV/AIDS (Including pneumocytosis) 

OTHER INFECTIOUS AND PARASITIC DISEASES 

bacterial enteritis (intestinal Infections) 

viral enteritis (intestinal Infections) 

ottier intestinal infections 

tuberculosis 

strep throat/scarlet fever 

ottier bacterial infections 

bacterial Infection in other diseases 

herpes zoster (shingles) 

herpes simplex 

viral hepatitis 

other viral infections 

late syphilis, symptomatic 

dermatophytosis (fungal skin infections, e.g., athlete's foot) 

thrush 

mycoses (fungal diseases), miscellaneous 

other infections 

LATE EFFECTS 
infection late effects 
cerebrovascular disease late effects 
injury late effects 



10 



10 



10 



10(2) 



EDCG 



EDGGP 



PIP 
ADDCG PIPDCG EDCG 



NON-PIP PIP 

EDCG EDCGP 



NON-PIP CONCURRENT CONCURRENT 
EDCGP ADDCQ PIPDCG 



10 



10 



10 



10 



20 



23 



23 



31(0) 



3 


5 




2 




2 


5 




1 


5 




2 




2 


1 




1 


5 




1 




1 


1 




3 


5 




1 




1 


1(0) 




1 


5 




1 




1 


1 




1 


5 




2 




2 


1 




5 


5 




4 




4 


8 




1 


5 




1 




1 







1 


5 




1 




1 


1 




1 


5 




2 




2 


1 




1 


5 




2 




2 


1 




1 


5 




1* 




1* 


1 




3 


5 




2 




2 


1 




3 


5 




4 




4 


1 




1 


5 




1 




1 


1 




1 


5 




1 




1 


1 




1 


8 




2 


2 


2 


1 


27 


5 


8 




4 


4 


4 


3 


27 


1 


8 




2 


2 


2 


3 


27 



1 

dcg\flna^Tat>-e1^nab 



TABLE E-1 

DIAGNOSTIC COST GROUPS BY DIAGNOSTIC CATEGORY, FOR ALTERNAT iVE DCG MODELS 



DXG 

6 

6.01 

6.02 

6.03 

6.04 

7 

7.01 

7.02 

7.03 

7.04 

7.05 

7.06 

8 

8.01 

9 

9.01 

10 
10.01 

11 

11.01 

12 

12.01 

12.02 

12.03 

12.04 

12.05 

13 

13.01 

13.02 



LABEL 



MOUThVPHARYNXAARYNX/OTHER RESPIRATORY CANCER 

cancer of mouth/tongue 

cancer of pharynx 

cancer of larynx 

other respiratory/intrafhoracic cancer 

STOMACH/SMALL BOWEULIVERff'ANCREAS/ESOPHAGUS CANCER 

cancer of esophagus 

cancer of stomach 

cancer of small tx>wel/peritoneum 

cancer of liver 

cancer of pancreas 

other, unspecified cancer of digestive organs/peritoneum 

COLON CANCER 
colon cancer 

RECTAL CANCER 
rectal cancer 

LUNG CANCER 
lung cancer 

BREAST CANCER 
breast cancer 

HODG KIN'S DISEASE/LYMPHOMA/MYELOMAfl-EUKEMIA 
lymphomayKarposi's sarcoma/Hodgkin's Disease 
multiple myeloma 
lymphoid leukemia 
myeloid leukemia 
other leukemia 

CANCER OF UTERUS/CERVIX/FEMALE GENITAL ORGANS 

cancer of uterus 

cancer of cervix/female genital organs 



1C 



EDCG 



EDCGP 







PIP 


NON-PIP 


PIP 


NON-PIP 


CONCURRENT 


CONCURRENT 


ADDCG 


PIPDCG 
12 


EDCG 
10 


EDCG 
4 


EDCGP 
10 


EDCGP 
4 


ADDCQ 


PIPDCG 


5 


1 


23 


10 


12 


10 


10 


10 


8 


3 


23 


4 


12 


10 


4 


10 


4 


1 


23 


4(1) 


12 


10 


4(1) 


10 


4(1) 


3 


23 


14 


14 


14 


14 


14 


10 


2 


31 


5 


14 


14 


4 


14 


4 


5 


31 


7 


14 


14 


4 


14 


4 


3 


31 


14 


14 


14 


7 


14 


8 


5 


31 


10 


14 


14 


8 


14 


8 


14 


31 


4 


14 


14 


4(1) 


14 


4(1) 


1 


31 



14 



12 



12 



20 



20 



23 



5 


17 


17 


4 


17 


4 


1 


35 


8 


- 17 


17 


8 


17 


8 


3 


35 


6 


17 


17 


6 


17 


6 


1 


35 


10 


17 


17 


8 


17 


8 


10 


35 


3 


17 


17 


6 


17 


6 


3 


35 


1 


6 


4 


2 


4 


2 


1 


12 


3 


6 


4 


2 


4 


2 


1 


12 



dcg\finaMab-e1Vieb 



TABLE E-1 

DIAGNOSTIC COST GROUPS BY DIAGNOSTIC CATEGORY, FOR ALTERNATIVE DOG MODELS 



DXG 

14 
14.01 

15 

15.01 

15.02 

16 

16.01 

17 

17.01 
17.02 
17.03 

18 

18.01 

18.02 

18.03 

18.04 

18.05 

18.06 

19 

19.01 
19.02 
19.03 
19.04 

20 

20.01 
20.02 
20.03 
20.04 
20.05 
20.06 
20.07 



LABEL 



CANCER OF PLACENTA/OVARY/UTERINE ADNEXIA 
cancer of ovaries/placenta/uferine adnexia 

CANCER OF PROSTATE/TESTIS/MALE GENITAL ORGANS 

prostate cancer 

cancer of testis/male genital organs 

CANCER OF BLADDERrt<IDNEY/URINARY ORGANS 
cancer of bladder/kidney/urinary organs 

NEOPLASM OF NERVOUS SYSTEM 

cancer of the eye 

cancer of the brain/nervous system/pituitary, pineal glandi 

benign neoplasm brain/nervous system/pituitary, pineal glands 

OTHER CANCER 

cancer of bione and articular cartilage 

cancer of connective and other soft tissue 

melanoma 

skin cancer, except melanoma. Including lip 

thyroid/endocrine cancer 

other/ill-detined site cancer 

SECONDARY CANCERS 

secondary cancer of lymph node 

secondary cancer of respiratory and digestive systems 

secondary cancer of other site 

disseminated cancer 

BENIGN NEOPLASMS 

benign neoplasm of digestive system 

benign neoplasm of respiratory system 

benign neoplasm of skin 

benign neoplasm of breast/other breast disorders 

benign neoplasm of urinary 

benign neoplasm of eye 

other benign neoplasms 



EDCG 



EDCGP 



ADDCG PIPDCG 



PIP 
EDCG 



NON-PIP 
EDCG 



PIP 
EDCGP 



NON-PIP 
EDCGP 



CONCURRENT 
ADDCG 



12 



CONCURRENT 
PIPDCG 



20 



10 
10 



14 



(1) 


8 


8 


4(1) 


8 


4(1) 


1 


31 


5 


8 


8 


4 


8 


4 


3 


31 


5 


8 


8 


4 


8 


4 


3 


31 


5 


8 


8 


5 


5 


5 


3 


14 


3 


8 


8 


4 


5 


4 


1 


14 


1 


8 


8 


2 


5 


2 


1 


14 


1 


8 


8 


2 


5 


2 


1 


14 


3 


8 


6 


2 


5 


2 


1 


14 


3 


8 


8 


4 


5 


4 


3 


14 


6 


17 


17 


6 


17 


6 


14 


31 


14 


17 


17 


12 


17 


12 


20 


31 


10 


17 


17 


8 


17 


8 


10 


31 


5 


17 


17 


6 


17 


6 


3 


31 


1 


3 


2 


2 


2 


2 


1 


10 


3 


3 


4 


4 






3 


10 




3 


2 


1 






1 


10 




3 


2 


1 









10 




3 


4 


4 






3 


10 




3 


2 


1 






1 


10 




3 


2 


2 


2 


2 


1 


10 



<]cg^flna^Tab-e1^rob 



TABLE E-1 

DIAGNOSTIC COST GROUPS BY DIAGNOSTIC CATEGORY, FOR ALTERNATIVE DCG MODELS 



DXG 

21 

21.01 

21.02 

21.03 

21.04 

21.05 

21.06 

22 
22.01 

23 

23.01 

24 

24.01 
24.02 
24.03 

25 

25.01 
25.02 

26 

26.01 

27 

27.01 

27.02 

27.03 

27.04 

27.05 

27.06 

27.07 

27,08 

27.09 

27.10 

27.11 



LABEL 



CARCINOMA IN SITU/NEOPLASM OF UNCERTAIN BEHAVIOR 

carcinoma In situ of digestive organs 

carcinoma in situ of respiratory system 

carcinoma in situ of other sites, except skin 

neoplasm of uncertain behavior, specified sites 

neoplasm of uncertain behavior nec/nos 

unspecified neoplasm 

DIABETES WITHOUT COMPLICATIONS 
diabetes without complications 

DIABETES WITH ACUTE COMPLICATIONS 
diabetes virith acute complications 

DIABETES WITH CHRONIC COMPLICATIONS 
diat}etes with renal manifestation 
diabetes with other specified complications 
diabetes vnth unspecified complications 

HYPOGLYCEMIA 
hypoglycemic coma 
other hypoglycemia 

DISORDERS OF FLUID/ELECTROLYTE/ACID BASE BALANCE 
disorders of fluid/electrolyte/acid-base balance 

OTHER ENDOCRINE/NUTRITIONAL/METABOLIC DISEASES 

goiter 

thyrotoxicosis, including Graves' disease 

thyroid disorders 

adrenal gland disorders, e.g., Cushing's syndrome 

ovarian dysfunction 

testicular dysfunction 

other endocrine disorders 

pituitary/parathyrold/thymus/polyglandular disorders 

protein-calorie malnutrition 

vitamin/other nutritional deficiencies (e.g., rickets, scurvy) 

disorders of lipoid metabolism (high cholesterol) 









EDCG 




EDCGP 


CONCURRENT 






PIP 


NON-PIP 


PIP 


NON-PIP 


CONCURRENT 


ADDCG 


PIPDCG 


EDCG 


EDCG 


EDCGP 


EDCGP 


ADDCG 


PIPDCG 


4 


5 


4 


4 


4 


4 


4 


14 


2(1) 


5 


2 


2 


2(1) 


2(1) 


10 


14 


3 


5 


2 


2 


2 


2 


3 


14 


3 


5 


4 


4 


4 


4 


3 


14 


1 


5 


2 


2 


2 


2 


1 


14 


2 


5 


2 


2 


2 


2 


1 


14 



3(2) 



12 



10 



12 



10 



23 



10 


12 


12 


8 


10 


8 


3 


14 


8 


12 


12 


6 


10 


6 


1 


14 


5 


12 


12 


4 


10 


4 


3 


14 


10 


12 


10 


10 


10 


10 


5 


8 


1 


12 


10 


2 


10 


2 


1 


8 



14 



1 


5 


1 


1 






1 


10 


1 


5 


1 


1 






1 


10 


1 


5 


1 


1 






1 


10 


5 


5 


4 


4 






3 


10 


1 


5 


1 


1 






1(0) 


10 


3 


5 


2 


2 


2 


2 


1 


10 


1 


5 


2 


2 


2 


2 


1(0) 


10 


3 


5 


2 


2 


2 


2 


1 


10 


10 


5 


10 


10 


8 


8 


14 


10 


1 


5 


2 


2 


2 


2 


1 


10 


1 


5 


1 


1 


1 


1 





10 



dcg\finaMat>-e1Vi«b 



TABLE E-1 

DIAGNOSTIC COST GROUPS BY DIAGNOSTIC CATEGORY, FOR ALTERNATIVE DCG MODELS 



DXG 

27.12 

27.13 
27.14 
27.15 
27.16 

28 

28.01 

28.02 

29 

29.01 

29.02 

30 

30.01 

30.02 

31 

31.01 

32 

32.01 

32.02 

33 

33.01 
33.02 

34 

34.01 

35 
35.01 

36 
36.01 



LABEL 



END STAGE LIVER DISORDERS 
end stage liver disorders 
esophageal varices 

OTHER LIVER DISORDERS 

cirrhosis 

other liver disorders, Including toxic hepatitis 

DISEASES OF ESOPHAGUS 
disease of esophagus 

ULCERS 

ulcer without perforation 

ulcer with perforation 

GASTRITIS/OTHER GASTRIC DISORDERS 

pyloric/duodena! obstruction 

gastritis/other gastric disorder (stomach disorders) 

APPENDICITIS 
appendicitis 

ABDOMINAL HERNIA/ COMPLICATED 
abdominal hernia, complicated 

ABDOMINAL HERNIA/ UNCOMPLICATED 
abdominal hernia/uncomplicated 



ADDCG PIPDCG 



disorders of plasma protein metabolism 
disorders of mineral metabolism 
metabolism disorders, nec/nos 
other hyperalimentation 
obesity/localized adiposity 

PANCREATITIS/ OTHER PANCREATIC DISORDERS 

acute pancreatitis 

chronic pancreatitis/other pancreatic diseases/intestinal malabsorption 



EDCG 



PIP 
EDCG 



5 


5 


4 


1 


5 


2 


1 


5 


1 


3 


5 


2 


1 


5 


1 


3 


8 


4 


5 


8 


4 


14 


17 


17 


14 


17 


17 


5 


10 


6 


3 


10 


6 



NON-PIP 
EDCG 



14 
14 



EDCGP 



PIP 
EDCGP 



NON-PIP 
EDCGP 



CONCURRENT CONCURRENT 
ADDCG PIPDCG 



20 
20 



4 . 


3 


10 


2 


1 


10 


1 


1 


10 


2 


1 


10 


1 


1 


10 


4 


5 


14 


4 


1 


14 


14 


14 


31 


8 


6 


31 


5 


1 


17 


2 


1 


17 



3 


5 


4 


2 


4 


2 


1 


10 


5 


5 


4 


4 


4 


4 


1 


10 


1 


8 


4 


4 


6 


4 


8 


7 


1 


8 


4 


2 


6 


2 


1 


7 



10 



12 



dcgVinaMab-elViab 



TABLE E-1 

DIAGNOSTIC COST GROUPS BY DIAGNOSTIC CATEGORY, FOR ALTERNA1 VE DCG MODELS 



EDCG 



EDCGP 



DXG 

37 

37.01 

37.02 

38 

38.01 
38.02 
38.03 



39.01 

40 

40.01 

40.02 

40.03 

40.04 

41 

41.01 
41.02 
41.03 

42 
42.01 

43 

43.01 

43.02 

44 

44.01 

44.02 

44.03 

44.04 



LABEL 



INFLAMMATORY BOWEL DISEASE 
regional enteritis (Crohn's disease) 
ulcerative colitis 

PERITONITIS/INTESTINAL OBSTRUCTION 

Intestinal obstruction 

peritonitis 

other peritoneal disorders 

DIVERTICULA OF INTESTINE 
divercula of intestine 

ANAL/RECTAUGASTROINTESTINAL DISORDERS 

hemorrhoids 

anal/rectal disorders 

intestinal abcess/ulceration/perforation 

other intestinal disorders 

GALLBLADDER DISORDERS 
cholelithiasis (gallstones) 
biliary tract disease 
other gallbladder disorders 

GASTROINTESTINAL HEMORRHAGE 
gastrointestinal hemorrhage 

GOUT/ARTHROPATHY/DERANGEMENTS 

gout/crystal arthropathy 

other arthropathy/joint disorders, derangements, joint pain/stiffness 

CONNECTIVE TISSUE DISEASES 

systemic lupus erythematosus, scleroderma, and other connective tissue disease 

rheumatoid arthritis und other inflammatory polyarthropathy 

inflammatory spondylopathies 

polymyalgia rheumatica 







PIP 


NON-PIP 


PIP 


NON-PIP 


CONCURRENT 


CONCURRENT 


ADDCG 


PIPDCG 


EDCG 


EDCG 


EDCGP 


EDCGP 


ADDCG 


PIPDCG 


3 


8 


8 


4 


8 


4 


1 


17 


3 


8 


8 


2 


8 


2 


1 


17 


5 


8 


6 


4 


6 


4 


8 


14 


4 


8 


6 


6 


6 


4 


27 


14 


5 


8 


6 


2 


6 


2 


8 


14 



1 


6 


4 


1 


4 


1 


1 


10 


1 


6 


A 


2 


4 


2 


1 


10 


3 


6 


A 


4 


A 


4 


3 


10 


3 


6 


A 


2 


A 


2 


1 


10 


3 


4 


2 


2 


2 


2 


3 


10 


3 


4 


4 


A 


4 


4 


8 


10 


3 


A 


2 


2 


2 


2 


3 


10 



10 



1 


5 


4 


2 


4 


2 





14 


3 


5 


4 


2 


4 


2 


1 


14 


3 


8 


8 


4 


7 


4 


1 


14 


3 


8 


8 


4 


7 


4 


1 


14 


1 


8 


8 


2 


7 


2 


1 


14 


2 


8 


8 


2 


7 


2 


1 


14 



6 

dcg\llna^Tab-e1Vub 



TABLE E-1 

DIAGNOSTIC COST GROUPS BY DIAGNOSTIC CATEGORY. FOR ALTERNATIVE DCG MODELS 



EDCG 



EDCGP 



DXG 

45 

45,01 

45.02 

46 
46.01 

47 

47.01 

48 
48.01 

49 

49.01 

49.02 

49.03 

49.04 

50 
50.01 

51 

51.01 

51.02 

51.03 

51.04 

51.05 

51.06 

51.07 

51.08 

52 

52.01 

52.02 

52.03 

52.04 



LABEL 



ARTHROPATHY/BONE INFECTION 
arthropathy with lnf< ction 
osteomyelitis 

OSTEOARTHRITIS 
osteoarthritis 

BACK DISORDERS (E.G.. HERNIATED DISC, LUMBAGO. SCIATICA. BACKACHE) 
back disorders (e.g., herniated disc, lumbago, sciatica, backache) 

DISORDERS OF SOFT TISSUES (E.G., TENDONITIS, BURSITIS) 
disorders of soft fa': sue (e.g., tendonitis, bursitis) 

OTHER BONE DISORDERS 

osteoporosis 

other bone disorders (e.g., curvature of spine, Pagefs disease) 

flat foot, acquired deformities of toe 

other acquired limb deformities 

IRON DEFICIENCY AND OTHERAJNSPECIFIED ANEMIAS 
iron deficiency and other/unspecified anemias 

OTHER BLOOD DISEASES 

sickle cell and other hereditary hemolytic anemias 

acquired hemolytic anemia 

aplastic anemia 

hemophilia and other coagulation defects 

purpura/thrombocytopathy/hemorrhagic conditions 

white blood cell disorders 

immune disorders 

other blood disease 

DEMENTIA 

senile/presenile psychoses 
other organic psychotic conditions 
cerebral degeneration/Alzheimer's disease 
senility without psychosis 







PIP 


NON-PIP 


PIP 


NON-PIP 


CONCURRENT 


CONCURRENT 


ADDCG 


PIPDCG 


EDCG 


EDCG 


EDCGP 


EDCGP 


ADDCG 


PIPDCG 


5(1) 


12 


10 


2 


10 


2 


1 


23 


5 


12 


10 


2 


10 


2 


1 


23 



10 



14 



10 



3 


7 


6 


2 


6 


2 


1 


14 


3 


7 


6 


2 


6 


2 


1 


14 


1 


7 


6 


2 


6 


2 


1 


14 


1 


7 


6 


2 


6 


2 


1 


14 



10 



3 


14 


14 


2 


14 


2 


1 


17 


10 


14 


14 


8 


14 


7 


3 


17 


14 


14 


14 


10 


14 


10 


10 


17 


5 


14 


14 


4 


14 


4 


3 


17 


3 


14 


14 


4 


14 


4 


1 


17 


3 


14 


14 


4 


14 


2 


1 


17 


5 


14 


14 


2 


14 


2 


2 


17 


3 


14 


14 


4 


14 


2 


1 


17 


5 


7 


7 


4 


7 


4 


1 


10 


3 


7 


7 


4 


7 


4 


3 


10 


5 


7 


7 


4 


7 


4 


1 


10 


4 


7 


7 


4 


7 


4 


1 


10 



<lcg\/inal\Tot)-e1Viab 



TABLE E-1 

DIAGNOSTIC COST GROUPS BY DIAGNOSTIC CATEGORY, FOR ALTERNATIVE 



DOG MODELS 



EDCG 



DXG 

53 

53.01 

53.02 



55 
55.01 

56 
56.01 

57 

57.01 

57.02 

58 
58.01 

59 

59.01 
59.02 
59.03 

60 

60.01 

60.02 

60.03 

60.04 

60.05 

60.06 

60.07 

60.08 

60.09 

60.10 

60.11 



LABEL 



SUBSTANCE-RELATED PSYCHOSES 
alcoholic psychoses 
drug psychoses 



54 DELIRIUM/HALLUCINATIONS 

54.01 delirium/delusions/hallucinations 

54.02 hallucinations, symptomatic 



SCHIZOPHRENIC DISORDERS 
schizophrenic disorders 

MANIC AND DEPRESSIVE DISORDERS, INCLUDING MAJOR DEPRESSIVE DISORDER 
manic and depressive disorders, including major depressive disorder 

PARANOIA AND OTHER PSYCHOSES 

paranoid states 

other nonorganic psychoses 

NEUROTIC DISORDERS 

neurotic disorders (e.g. anxiety, panic attack, phobias) 

SUBSTANCE ABUSE AND DEPENDENCE 
alcohol dependence 
drug dependence 
non-dependent abuse of drugs 

OTHER MENTAL DISORDERS 

personality disorders 

sexual deviations and disorders 

psychophysiologic disorders 

acute reaction to stress 

adjustment reaction 

nonpsychotic organic brain Si drome 

depression, not elsewhere classified 

behavior disorder 

developmental behavioral disorders 

mental retardation 

other mental disorders 



ADDCG PIPDCG 



10 



PIP 
EDCG 



NON-PIP 
EDCG 



6 
4 



10 



2 

4 



EDCGP 



PIP 
EDCGP 



10 
10 



NON-PIP 
EDCGP 



10 



CONCURRENT 
ADDCO 



8 

10 



10 

4 



CONCURRENT 
PIPDCQ 



e 

6 



14 
14 



12 



17 



10 



5 
8 
1 


5 
5 
5 


5 
5 
5 


2 

5 

2 


5 
5 
5 


2 
5 
2 


4 
10 
1 


8 
8 
8 


6 

2 
2(1) 

2 

3 

3 

3 
2(1) 


7 
7 
7 
7 
7 
7 
7 
7 


2 
2 
2 
2 
2 
4 
2 
2 


2(1) 

2 
2(1) 

2 

2 

4 

2 

2 
2(1) 
2(1) 

2 


7 
7 
7 
7 
7 
7 
7 


2(1) 

2 
2(1) 

2 

2 

4 

2 


8 


8 
8 
8 

8 
8 
8 
8 


2(1) 

2(1) 

2 


7 
7 
7 


2 
2 
2 


7 
7 

7 
7 


2 

2(1) 

2(1) 

2 



1 


8 
8 
8 
8 



8 

acgVinal\Tab-e1Viab 



TABLE E-1 

DIAGNOSTIC COST GROUPS BY DIAGNOSTIC CATEGORY, FOR ALTERNATIVE DCG MODELS 



DXG 



LABEL 



ADDCG PIPDCG 



EDCG 



PIP 
EDCG 



NON-PIP 
EDCG 



EDCGP 



PIP 
EDCGP 



NON-PIP 
EDCGP 



CONCURRENT 
ADDCO 



CONCURRENT 
PIPDCG 



61 HEADACHES 

61 .01 headaches, Including migraine 

62 DEGENERATIVE NEUROLOGIC DISORDERS 

62.01 Parkinson's disease 

62.02 Huntington's Disease, essential tremor, other abnormal movement disorders 

62.03 anterior horn cell disease, including Lou Gehrig's disease (ALS) 

62.04 other spinal cord disease 

62.05 autonomic nerve disorder 

62.06 Tay-Sachs, other hereditary and degenerative central nervous system diseases 

63 OTHER NEUROLOGIC DISORDERS 

63.01 multiple sclerosis, other central nervous system dymelination 

63.02 infantile cerebral palsy 

63.03 quadriplegia 

63.04 paraplegia 

63.05 Cauda equina syndrome 

63.06 other paralytic disorders 

63.07 nervous/musculoskeletal system symptoms 

63.08 other central nervous system disorders 

64 EPILEPSY AND OTHER SEIZURE DISORDERS/CONVULSIONS 
64.01 epilepsy and other seizure disorders/convulsions 

65 MONONEUROPATHY 

65.01 trigeminal nerve disorders 

65.02 facial nerve disorders, including Bell's Palsy 

65.03 root/plexus disorders 

65.04 root/plexus lesions 

65.05 other cranial nerve disorders 

65.06 neuropathy of upper limb (e.g., carpal tunnel syndrome) 

65.07 neuropathy of leg 



5 


8 


1 


8 


5 


8 


5 


8 


6 


8 


5 


8 


3 


10 


1 


10 


10 


10 


10 


10 


5 


10 


3 


10 


3 


10 


5 


10 



6 


4 


7 


6 


2 


7 


6 


6 


7 


6 


4 


7 


6 


6 


7 


6 


4 


7 


8 


2 


8 


8 


2(1) 


8 


6 


6 


8 


10 


10 


10 


8 


6 


8 


8 


4 


8 


8 


4 


8 


8 


4 


8 



2 

1 

6 

10 

6 

4 

4 

4 



14 
14 
14 
14 
14 
14 



17 
17 
17 
17 
17 
17 
17 
17 



10 



2 


8 


5 


2 


5 


2 




10 




8 


5 


2(1) 


5 


2(1) 




10 




8 


5 


2 


5 


2 




10 




8 


5 


2 


5 


2 




10 




8 


5 


2 


5 


2 




10 




8 


5 


2 


5 


2 




10 




8 


5 


2 


5 


2 




10 



9 

dcgMlnaftTab-elViab 



TABLE E-1 

DIAGNOSTIC COST GROUPS BY DIAGNOSTIC CATEGORY, FOR ALTERNATIVE DCG MODELS 



EDCG 



EDCGP 



DXO 

66 

66.01 

66.02 

66.03 

66.04 

66.05 

67 

67.01 

68 

68.01 
68.02 
68.03 

69 

69.01 

69.02 

70 

70.01 

70.02 

70.03 

70.04 

70.05 

71 

71.01 
71.02 
71.03 

72 
72.01 

73 

73.01 



LABEL 



POLYNEUROPATHY 

inflammatory/toxic neuropathy, including Guillian-Barre Syndrome 

myoneural disorders/myasthenia gravis 

muscular dystrophies 

other neuropathy 

peripheral neuropathy 

CEREBRAL CYSTS, COMPRESSION. EDEMA, ANOXIC DAMAGE, 
cerebral cysts, compression, edema, anoxic damage, other brain conditions 

VALVULAR AND RHEUMATIC HEART DISEASE 
rheumatic fever/heart disease 
mitral or aortic valve/endocardia disease 
mitral/aortic valve disorders 



HYPERTENSION, UNCOMPLICATED 
essential hypertension 
hypertensive heart disease 

HYPERTENSION, COMPLICATED 
malignant hypertension 
malignant hypertensive heart disease 
hypertensive heart and renal disease 
secondary hypertension 
hypertension encephalopathy 

MYOCARDIAL INFARCTION 

myocardial infarction 

old myocardial infarction 

other chronic ischemic heart disease 

ACUTE MYOCARDIAL INFARCTION 
acute myocardial it arction 

OTHER ACUTE ISCHEMIA 
other acute ischemia 







PIP 


NON-PIP 


PIP 


NON-PIP 


CONCURRENT 


CONCURRENT 


ADDCG 


PIPDCG 
14 


EDCG 
14 


EDCG 

4 


EDCGP 
14 


EDCGP 
4 


ADDCO 


PIPDCO 


5 


1 


17 


8 


14 


14 


6 


14 


6 


3 


17 


3 


14 


14 


4 


14 


4 


1 


17 


8 


14 


14 


6 


14 


7 


1 


17 


2(1) 


8(14) 


5(14) 


2(1) 


5(14) 


2(1) 


1 


10 



10 



10 



10 



17 



23 



7 


6 


6 


4 


6 


4 


3 


35 


3 


6 


6 


4 


6 


4 


1 


35 


7 


6 


6 


4 


6 


4 


3 


35 


1 


8 


8 


2 


B 


2 





14 


1 


8 


8 


2 


B 


2 


1 


14 


1 


8 


6 


2 


6 


2 





B 


3 


8 


6 


2 


6 


2 


1 


6 


3 


8 


6 


2 


6 


2 


1 


8 


2(1) 


8 


6 


2(1) 


6 


2(1) 


1 


8 


3 


8 


6 


2 " 


6 


2 


3 


8 


5 


5 


4 


4 


4 


4 


1 


23 


5 


5 


4 


4 


4 


4 


1 


23 


3 


5 


4 


4 


4 


4 


1 


23 



17 



12 



10 

dcgMlnaMab-elViab 



TABLE E-1 

DIAGNOSTIC COST GROUPS BY DIAGNOSTIC CATEGORY, FOR ALTERNATIVE DCG MODELS 



DXG 

74 
74.01 

75 

75.01 

75.02 

76 

76.01 

76.02 

77 
77.01 

78 
78.01 

79 
79.01 

80 
80.01 



LABEL 



ANGINA PECTORIS 
angina pectoris 

PULMONARY HEART DISEASE 
pulmonary embolism (blood clot) 
other pulmonary heart disease 

RHYTHM AND CONDUCTION DISORDERS 
conduction disorders/cardiac dysrhythmias 
premature heart beats 

ATRIAL ARRHYTHMIA 
atrial arrhythmia 

VENTRICULAR TACHYCARDIA 
ventric tachycardia 

HEART ARREST/ SHOCK 
heart arrest/shock 

HEART FAILURE 
heart failure 



EDCG 



EDCGP 



PIP NON-PIP PIP NON-PIP CONCURRENT CONCURRENT 
ADDCG PIPDCG EDCG EDCG EDCGP EDCGP ADDCO PIPDCQ 



3 


6 


5 


4 


S 


4 


8 


17 


7 


6 


5 


4 


5 


4 


3 


17 


3 


5 


4 


2 


4 


2 


1 


10 


3 


5 


4 


2 


4 


2 


1 


10 



8(1) 



10 



10(2) 



12 



8* 



12 



8(1) 



12 



6(1) 



23 



31 



14 



81 OTHER CARDIAC DISEASE 

81 .01 pericarditis, post-MI 

81 .02 acute endo/myocarditis 

81 .03 cardiomyopathy/myocarditis 

81 .04 cardlomegaly (enlarged heart) 

81 .05 other heart disease 



3 


6 


6 


4(1) 


5 




3 


23 


3(1) 


6 


6 


4 


5 




1 


23 


3 


6 


6 


4 


5 




3 


23 


5 


6 


6 


4 


5 




3 


23 


3 


6 


6 


4 


5 




1 


23 



82 CEREBRAL HEMORRHAGE 
82.01 cerebral hemorrhage 

83 PRECEREBRAL ARTERIAL OCCLUSION 
83.01 precerebral arterial occlusion 



23 



10 



11 

dC8\(lnaMat)-e1\nab 



TABLE E-1 

DIAGNOSTIC COST GROUPS BY DIAGNOSTIC CATEGORY, FOR ALTERNATIVE DCG MODELS 



DXG 

84 

84.01 
84.02 
84.03 

85 
85.01 



LABEL 



CEREBROVASCULAR DISEASE 
cerebrovascular accident (stroke) 
hemiplegia (paralysis of one side of body) 
aphasia (loss of language skills/comprehension) 

TRANSIENT CEREBRAL ISCHEMIA 
transient cerebral ischemia 



EDCG 



EDCGP 







PIP 


NON-PIP 


PIP 


NON-PIP 


CONCURRENT 


CONCURRENT 


ADDCG 


PIPDCG 


EDCG 


EDCG 


EDCGP 


EDCGP 


ADDCG 


PIPDCG 


5 


8 


8 


4 


8 


4 


1 


14 


8 


8 


8 


6 


8 


8 


14 


14 


8 


8 


8 


8 


8 


8 


14 


14 



86 ATHEROSCLEROSIS 

86.01 atherosclerosis/arteriosclerosis of major vessel 

86.02 atherosclerosis/general, arteriosclerotic cardiovascular disease, arteriosclerosis/general 

87 ANEURYSM 

87.01 aortic aneurysm 

87.02 other aneurysm 

88 ARTERIAL EMBOLISM AND THROMBOSIS 
88.01 arterial embolism and thrombosis (blood clots) 

89 PERIPHERAL VASCULAR DISEASE 

89.01 specified peripheral vascular disease 

89.02 Raynaud's syndrome 

89.03 peripheral vascular disease 

89.04 other arterial disease 

89.05 disease of capillaries 

89.06 vascular insufficiency of intestines 

89.07 gangrene 

90 THROMBOPHLEBITIS 

90.01 phlebitis and thrombophlebitis 

90.02 noninfectious lymphatic disorders 

90.03 hemorrhage nos 

90.04 compression of vein 

91 HYPOTENSION (LOW BLOOD PRESSURE) 
91 .01 hypotension (low blood pressure) 



5 


8 


7 


4 


8 


4 


1 


23 


3 


8 


7 


2 


8 


2 


1 


23 


5 


6 


6 


6 


6 


6 


3 


31 


5 


6 


6 


6 


6 


6 


3 


SI 



10 



10 



27 



5 


10 


10 


4 


10 


4 


1 


27 


1 


10 


10 


1 


10 


1 


1(0) 


27 


S 


10 


10 


4 


10 


4 


1 


27 


5 


10 


10 


4 


10 


4 


3 


27 


1 


10 


10 


4 


10 


4(1) 


1 


27 


7 


10 


10 


6 


10 


6 


8 


27 


12 


10 


10 


10 


10 


10 


23 


27 


1 


6 


4 


2 


4 


2 


1 


7 


3 


6 


4 


4 


4 


4 


3 


7 


1 


6 


4 


1* 


4 


1* 


3 


7 


1 


6 


4 


2(1) 


4 


2(1) 


1 


7 



12 

dcijVflnaMab-elViab 



TABLE E-1 

DIAGNOSTIC COST GROUPS BY DIAGNOSTIC CATEGORY, FOR ALTERNATIVE DCG MODELS 



EDCG 



EDGQP 



DXG 

92 

92.01 

92.02 

92.03 

92.04 

93 

93.01 

93.02 

93.03 

93.04 

93.05 

93.06 

93.07 

93.08 

93.09 

94 

94.01 

94.02 

94.03 

94.04 

94.05 

95 

95.01 

95.02 

95.03 

95.04 

95.05 

95.06 

95.07 

95.08 

95.09 

96 
96.01 



LABEL 



OTHER CIRCULATORY DISEASE 

superficial phlebitis-leg 

varicose veins 

other circulatory disease/postphlebitic syndrome 

other specified circulatory disorders 

DISORDERS OF THE EYE AND ADNEXA 

diabetic retinopathy 

proliferative diabetic retinopathy 

endophthalmitis (eye inflammation) 

retinal disorders 

glaucoma 

cataract/lens replacement 

disorders of refraction and accommodation (e.g., far-, near-sightedness, astigmatism) 

vitreous hemorrhage 

other eye disorders 

EAR DISORDERS 

Impacted earwax 

otitis media (middle ear infection) 

vertiginous syndromes (e.g., vertigo, Meniere's disease) 

hearing loss 

other ear disorders 

NOSE/ THROAT DISEASES 

acute nose/throat infection (e.g., common cold) 

nasal polyps/allergic rhinitis (e.g., hay fever) 

chronic sinusitis 

larynx/vocal cord diseases 

paralysis of vocal cords/larynx 

disorders of teeth, gum, and jaw (e.g., gingivitis, periodontitis) 

other diseases of upper respiratory system 

salivary gland diseases 

other oral soft tissue/tongue/jaw disorders 

EMPHYSEMA/CHRONIC BRONCHITIS 
emphysema/chronic bronchitis 







PIP 


NON-PIP 


PIP 


NON-PIP 


CONCURRENT 


CONCURRENT 


ADDCG 


PIPDCG 
6 


EDCG 
8 


EDCG 
2 


EDCGP 
8 


EDCGP 
2 


ADDCG 


PIPDCG 


3 


1 


10 


1 


8 


8 


2 


8 


2 


1 


10 


5 


6 


8 


4 


8 


4 


1 


10 


3 


8 


8 


2 


8 


2 


1 


10 


5 


5 


4 


4 


4 


4 


1 


6 


5 


5 


6 


6 


6 


6 


1 


6 


1 


5 


2 


2 


2 


2 


1 


6 


1 


S 


2 


2 


2 


2 


1 


6 


1 


5 


2 


2 


2 


2 


1 


6 


1 


5 


2 


2 


2 


2 


1 


6 


1 


5 


2 


1 


2 


1 





6 


2 


5 


2 


2 


2 


2 


3 


6 


1 


5 


2 


1 


2 


1 


1 


6 


1 


3 


2 


2 


2 


2 








1 


3 


1 


1 


1 


1 








1 


3 


1 


1 


1 


1 


1 





1 


3 


1 


1 


1 


1 


1 





1 


3 


2 


2 


2 


2 


1 





1 


S 


1 


1 


1 


1 





6 


1 


5 


1 


1 


2 


2 


1 


6 


1 


5 


2 


2 


2 


2 


1 


6 


3 


5 


2 


2 


2 


2 


1 


6 


7 


5 


6 


6 


6 


6 


3 


6 


1 


5 


1 


1 


1 


1 


1 


6 


1 


5 


2 


2 


2 


2 


1 


6 


3 


S 


2 


2 


2 


2 


1 


6 


1 


5 


2 


2 


2 


2 


1 


6 



14 



14 



14 



14 



13 
dcgVlnal\Tal>-«1Viat) 



TABLE E-1 

DIAGNOSTIC COST GROUPS BY DIAGNOSTIC CATEGORY, FOR ALTERNATIVE DCG MODELS 



DXG 

97 
97.01 



LABEL 



OTHER BRONCHITIS 
other bronchitis 



ADDCG PIPDCG 



EDCG 



PIP 
EDCG 



NON-PIP 
EDCG 



EDCGP 



PIP 
EDCGP 



NON-PIP 
EDCGP 



CONCURRENT CONCURRENT 
ADDCG PIPDCG 



98 VIRAL PNEUMONIA/INFLUENZA 

98.01 viral pneumonia 

98.02 influenza 



3 


5 


5 


4 


5 


2 


3 


10 


1 


5 


5 


2 


5 


2 


1 


10 



99 GRAM-NEGATIVE/STAPHYLOCOCCUS PNEUMONIA 
99.01 gram-negative/staphylococcus pneumonia 

1 00 BACTERIAL PNEUMONIA 

1 00.01 pneumococcal and other specific bacterial pneumonia 

100.02 other and unspecified pneumonia 

101 ASTHH4A 
101.01 asthma 

1 02 LUNG DISEASES DUE TO EXTERNAL AGENTS 

102.01 bronchiectasis/lung diseases due to specified external agents (e.g., black lung disease) 

102.02 aspiration pneumonia 

1 02 .03 respiratory conditions due to other and unspecified external agents/postinflammatory fibrosis 

1 03 PLEURISY/PNEUMOTHORAX (COLLAPSED LUNG) 
103.01 pleurisy/pneumothorax (collapsed lung) 

104 OTHER LUNG DISEASE 

1 04.01 empyema/abscess of lung 

104.02 pulmonary congestion/hypostasis 

104.03 acute lung edema nos 

1 04.04 post trauma/surgery pulmonary insufficiency 

104.05 other lung disease 

105 RESPIFJATORY FAILURE/ARREST 

105.01 respiratoryfailure 

105.02 respiratory arrest 



10 



12 



10 



10 



10 



10 



10 



10 



23 



10 



23 



5 


7 


6 


2(1) 


6 


2(1) 


6 


10 


3 


7 


6 


2 


6 


2 


1 


10 



10 



3 


14 


14 


4 


10 


4 


1 


31 


14 


14 


14 


10 


10 


10 


23 


31 


3 


14 


14 


4 


10 


4 


1 


31 



17 



8 


14 


12 


6 


8 


8 


3 


23 


3 


14 


12 


2 


8 


2 


1 


23 


14 


14 


12 


12 


14 


14 


17 


23 


8 


14 


12 


8 


8 


8 


40 


23 


3 


14 


12 


4 


8 


2 


3 


23 


7 


17 


17 


4 


14 


4 


6 


35 


17 


17 


17 


17 


14 


14 


40 


35 



14 
<)cg\(ln«Mal>-e1Vial) 



TABLE E-1 

DIAGNOSTIC COST GROUPS BY DIAGNOSTIC CATEGORY, FOR ALTERNATIVE DCG MODELS 



EDCG 



EDCOP 



DXG 

106 

106.01 

106.02 

106.03 

106.04 

106.05 

107 
107.01 

108 
108.01 

109 

109.01 

109.02 

110 
110,01 

111 
111.01 

112 
112.01 
112.02 
112.03 

113 

113.01 

113.02 

113.03 

113.04 

113.05 

114 
114,01 



LABEL 



RENAL FAILURE 
nephritis, dialysis encounter 
acute renal failure 
chronic renal failure 
renal failure, unspecified 
Impaired renal function 

KIDNEY INFECTION 
kidney infection 

RENAUURETERAUBLADDER CALCULUS 
renal/ureteral/bladder calculus (e.g., kidney stones) 

OTHER RENAUURETERAL DISEASES 

urethral stricture 

hydronephrosls/other renal/urethral disorders 

OTHER URINARY TRACT INFECTIONS 
cystitis, other urinary tract infections 

OTHER URINARY DISORDERS 
other urinary disorders 

PROSTATE/TESTICULAR/PENILE DISORDERS 
hyperplasia of prostate 
other prostatic disorders 
penis/testis/male genital organs disorders 

DISEASES OF FEMALE GENITAL ORGANS 

diseases of female pelvic organs 

vaginal and cervical diseases 

other diseases of female genital organs 

female stress incontinence 

menopausal and postmenopausal disorders 

GENITAL PROLAPSE 
genital prolapse 







PIP 


NON-PIP 


PIP 


NON-PIP 


CONCURRENT 


CONCURRENT 


ADDCG 


PIPDCG 


EDCG 


EDCG 


EDCGP 


EDCGP 


ADDCO 


PIPDCG 


7 






4 


14 


4 


3 


23 


14 






14 


14 


12 


27 


23 


10 






8 


14 


8 


3 


23 


7 






6 


14 


6 


3 


23 


5 






4 


14 


4 


1 


23 



3 


8 


8 


2 


8 


2 


1 


10 


3 


8 


8 


4 


8 


4 


1 


10 



10 



10 



10 



10 



1 


3 


2 


2 


2 


2 


1 


5 


1 


3 


2 


2 


2 


2 


1 


5 


1 


3 


2 


2 


2 


2 


1 


5 


1 


3 


2 


2 


2 


a 


1 


6 


1 


3 


2 


1 


2 


« 


1 


6 


1 


3 


2 


1 


2 


1 


1 


6 


1 


3 


2 


2 


2 


2 


1 


6 


1 


3 


2 


1 


2 


« 





6 



15 

dcgVlnaftTal>-e1V»b 



TABLE E-1 

DIAGNOSTIC COST GROUPS BY DIAGNOSTIC CATEGORY, FOR ALTERNATIVE DCG MODELS 



DXG 

115 
115.01 
115.02 
115.03 



LABEL 



PREGNANCY/PERINATAL CONDITIONS 
pregnancy/birth complications, mother/child 
pregnancy with abortive outcome 
normal pregnancy/delivery 



1 1 6 DERMATOLOGICAL DISORDERS 

1 1 6.01 cellulita's/abscess/other local skin infection 

1 1 6.02 bullous dermatoses 



EDCG 



EDCGP 







PIP 


NON-PIP 


PIP 


NON-PIP 


CONCURRENT 


CONCURRENT 


ADDCG 


PIPDCG 


EDCG 


EDCG 


EDCGP 


EDCGP 


ADDCQ 


PIPDCG 


1 


2 


1 


1 


1 


1 


1 





3 


2 


1 


1 


1 


1 


1 





1 


2 


1 


1 


1 


1 


1 





3 


8 


8 


2 


8 


2 


1 


8 


3 


8 


8 


4 


8 


4 


1 


8 



117 CHRONIC ULCER OF SKIN 

1 1 7.01 chronic ulcer of skin 



14 



14 



14 



31 



1 1 8 OTHER DEMATOLOGICAL DISORDERS 

1 18.01 dermatitis due to substances taken internally (e.g., food, drugs) 

1 1 8.02 psoriasis and similar disorders 

1 1 8.03 other dermatosis 

1 1 8.04 diseases of nail (e.g ., ingrown toenail) 

1 1 8.05 other dermatological disorders 

1 1 9 CONGENITAL ANOMALIES 

1 1 9.01 spina bifida, other congenital anomalies of nervous system 

1 1 9.02 congenital anomalies of eye 

1 1 9.03 congenital anomalies of cardiac/circulatory systems 

1 1 9.04 congenital anomalies of musculoskeletal/limb 

1 1 9.05 congenital anomalies of skin 

119.06 chromosomal anomalies 

1 1 9.07 other congenital anomalies 

120 GENERAL SYMPTOMS 

120.01 somatic/segmental dysfunction 

120.02 dizziness and giddiness 

1 20.03 malaise and fatigue 

120.04 other general symptoms 

121 COMA/ SYNCOPE 

121.01 coma 

1 21 .02 syncope (fainting) and collapse 



1 


5 


1 


1 


1 


1 


1 


10 


1 


5 


2 


2 


2 


2 


1 


10 


1 


5 


1 


1 


1 


1 





10 


3 


5 


4 


4 


4 


4 


1 


10 


1 


5 


1 


1 


1 


1 


1 


10 


5 


6 


7 


4 


7 


4 


1 


23 


1 


6 


7 


1 


7 


1 


1 


23 


3 


6 


7 


4 


7 


4 


1 


23 


3 


6 


7 


2 


7 


2 


1 


23 


2 


6 


7 


2 ■ 


7 


2 


1 


23 


1 


6 


7 


1 


7 


1 


1(0) 


23 


1 


6 


7 


2 ' 


' 7 


2 


1 


23 


1 


6 


5 


2 


5 


2 


1 


6 


1 


6 


S 


2 


5 


2 


1 


6 


1 


6 


5 


2 


5 


2 


1 


6 


1 


6 


5 


2 


5 


2 


1 


6 


5 


6 


6 


4 


6 


5 


8 


5 


3 


6 


6 


4 


6 


4 


3 


5 



16 

dC8\)lna^Tat>-e1\nat) 



TABLE E-1 

DIAGNOSTIC COST GROUPS BY DIAGNOSTIC CATEGORY. FOR ALTERNATIVE DCG MODELS 



DXG 

122 
122.01 



LABEL 



FEVER 
fever 



EDGG 



ADDCG PIPDCG 



PIP 
EDCG 



10 



NON-PIP 
EDCG 



EDCGP 



PIP 
EDCGP 



NON-PIP 
EDCGP 



CONCURRENT 
ADDCO 



CONCURRENT 
PIPDCG 



1 23 RESPIFJATORY/OTHER CHEST SYMPTOMS 

123.01 dyspnea (labored breathlng)/other resp abnormalities 

123.02 hemoptysis (coughing up blood) 

123.03 cough 

1 23.04 respiratory/other chest symptoms 

124 CARDIOVASCULAR SYMPTOMS 

124.01 chest pain 

1 24.02 other cardiovascular symptoms 

1 25 URINARY SYSTEM/ABDOMINAL-PELVIS SYMPTOMS 

1 25.01 retention of urine 

125.02 incontinence/urethral discharge 

125.03 other urinary system symptoms 

125.04 abdominal/pelvis symptoms 

126 VERTEBRAL INJURY 

1 26.01 vertebral fracture without spinal cord Injury 

126.02 vertebral fracture with spinal cord Injury 

127 FRACTURES OF SKULUFACE/NASAL BONE 

127.01 fractures of skull/face 

127.02 fractures of nasal bone 

128 PELVIC FRACTURE 
1 28.01 pelvic fracture 

129 FEMORAL FRACTURE 
129.01 femoral fracture 

130 LOWER LIMB FRACTURES (E.G., LEG, ANKLE, FOOT) 
130.01 fractures of lower limb (e.g., leg, ankle, foot) 



3 


5 


4 


4 


4 


4 


1 


S 


4 


5 


4 


4 


4 


4 


1 


5 


1 


5 


4 


2 


4 


2 


1 


5 


3 


5 


4 


2 


4 


2 


1 


5 


3 


5 


4 


2 


4 


2 


1 


4 


1 


5 


4 


2 


4 


2 


1 


4 


5 


7 


7 


4 


7 


4 


5 


6 


3 


7 


7 


4 


7 


4 


1 


6 


1 


7 


7 


2 


7 


2 


1 


6 


3 


7 


7 


2 


7 


2 


1 


6 


5 


7 


6 


4 


6 


4 


3 


10 


6 


7 


6 


6 


6 


6 


3 


10 


1 


3 


2 


2 


2 


2 


3 


14 


3 


3 


2 


2 


2 


2 


1 


14 



10 



17 



17 

clcg\/inaMat>-e1\nat) 



TABLE E-1 

DIAGNOSTIC COST GROUPS BY DIAGNOSTIC CATEGORY, FOR ALTERNATIVE DCG MODELS 



EDCO 



EDCOP 



DXG 

131 

131.01 

131.02 

131.03 

131.04 

131.05 

131.06 

131.07 

132 

132.01 

132.02 

132.03 

132.04 

132.05 

132.06 

132.07 

132.08 

132.09 

133 
133.01 

134 

134.01 

134.02 

134.03 

134.04 

134.05 

135 
135.01 

136 

136.01 

136.02 

136.03 

136.04 



LABEL 



FRACTURE/DISLOCATION 

shoulder dislocation 

dislocation of hip 

dislocation of knee, including cartilage/meniscus fear 

other dislocations 

fracture of rib, closed 

handAvrist/lower arm fracture 

other fractures 

INTERNAL AND/OR OPEN WOUND 

foreign body in pharynx/larynx 

injury to heart/lung/intrathoracic organs/blood vessels of thorax 

gastrointestinal/llver/kidney/spleen/pelvis injury 

open wound of eye 

open wound/injury of lower arm 

open wound of other sites 

traumatic amputation of leg/hand/footrtoe 

cnjshing Injury 

foreign body in eye/ear/nose 

SPFJAINS 
sprains 

CONTUSIONS/ACCIDENTS/INJURY, SUPERFICIAL AND NOS 

concussion 

contusion/superficial injury 

accidental falls 

attempted suicide/self-inflicted injury 

other accidents 

INTRACRANIAL INJURY 
intracranial injury 

BURNS/NERVE, SPINAL CORD INJURES 

third degree burns 

other burns 

nerve injury (including spinal cord injury without spinal bone injury) 

early complications of trauma 







PIP 


NON-PIP 


PIP 


NON-PIP 


CONCURRENT 


CONCURRENT 


ADDCG 


PIPDCG 


EDCG 


EDCG 


EDCGP 
4 


EDCGP 

2 


ADDCO 


PIPDCG 


3 


4 


2 


1 


8 


6 




6 


6 


6 


6 


17 


8 


3 




4 


2 


4 


2 


2 


8 


1 




4 


1 


4 


1 


1 


8 


3 




4 


4 


4 


4 


1 


8 


1 




4 


2 


4 


2 


1 


8 


1 




4 


2 


4 


2 


1 


8 


3 


3 


4 


4 


4 


4 


1 


10 


3(1) 


3 


2 


2 


2 


2 


3 


10 


5 


3 


4 


4 


4 


4 


3 


10 


1 


3 


2 


2 


2 


2 


1 


10 


1 


3 


2 


2 


2 


2 


1 


10 


1 


3 


2 


2 


2 


2 


1 


10 


8 


3 


6 


6 


6 


6 


4 


10 


2 


3 


1 


1 


1 


1 


1 


10 


1 


3 


1 


1 


2 


2 


1 


10 



3 


5 




2 


4 


2 




6 


1 


5 




2 


4 


2 




6 


2 


S 




4 


4 


4 




6 


10 


5 


10 


10 


10 


10 


14 


6 


1 


5 




1 


4 


1 




6 



23 



5 


8 


7 


6 


7 


4 


S 


23 


1 


8 


7 


2 


7 


2 


1 


23 


1 


8 


7 


2 


7 


2 


1 


23 


1 


8 


7 


2(1) 


7 


2(1) 


1 


23 

18 

dcgVina^T«t>-e1\nal> 



TABLE E-1 

DIAGNOSTIC COST GROUPS BY DIAGNOSTIC CATEGORY, FOR ALTERNATIVE DCG MODELS 



DXG 



LABEL 



ADDCG PIPDCG 



EDCG 



PIP 
EDCG 



NON-PIP 
EDCG 



EDCGP 



PIP 
EDCGP 



NON-PIP 
EDCGP 



CONCURRENT 
ADDCG 



CONCURRENT 
PIPDCG 



137 POISONING/TOXIC EFFECTS 

1 37.01 accidental poisoning by prescription or over-the-counter medications/biological substances, 
including medication errors 

1 37.02 poisoning by specified nonmedicinal substances/injury by certain external causes 

1 37.03 poisoning by other nonmedicinal substances 

137.04 allergy, unspecified 

1 37.05 adverse effects of correctly prescribed and administered drugs in therapeutic use 

1 38 COMPLICATIONS OF MEDICAL PROCEDURES AND CARE 

1 38.01 malfunction of infernal orthopedic device/graft 

1 38.02 infection/inflammation due to internal device/graft, transplant failure/rejection 

1 38.03 other complications of certain specified medical procedures 

1 38.04 other complications of medical and surgical procedures, nee (e.g., post-operative infection) 

1 38.05 misadventure or abnormal reaction/complication of patient during surgery or medical care 

1 39 ORGAN REPLACEMENTH-RANSPLANT/POST-SURGICAL STATES 

1 39.01 kidney, heart, heart valve (human/animal tissue), lung, liver b-ansplant 

1 39.02 other organ transplant 

1 39.03 heart, heart valve replacement by artificial device 

139.04 joint replacement 

1 39.05 other organ replacement 

139.06 artificial opening status/attention 

139.07 postsurgical states, eye 

1 39.08 other postsurgical states, including dialysis status 

1 39.09 aspirator, respirator, other machine dependence 

140 REHABILITATION PROCEDURES 
140.01 rehabilitation procedures 

141 RADIOTHERAPY 
141.01 radiation therapy 

142 CHEMOTHERAPY 
142.01 chemotherapy 



1 


7 


6 


2 


6 


2 


1 


7 


1 


7 


6 


1 


6 


1 


1(0) 


7 


1 


7 


6 


2 


6 


2 





7 


1 


7 


6 


2 


6 


2 


1 


7 


5 


7 


6 


6 


6 


6 


4 


23 


14 


7 


14 


14 


12 


12 


27 


23 


5 


7 


6 


6 


6 


6 


14 


23 


3 


7 


6 


2 


6 


2 


14 


23 


3(1) 


7 


6 


2(1) 


6 


2(1) 


17 


23 


5 


8 


6 


5 


5 




3 


23 


1 


8 


6 


2 


4 




1 


23 


4 


8 


6 


4 


4 




3 


23 


5 


8 


6 


4 


4 




8 


23 


4 


8 


6 


4 


4 




3 


23 


7 


8 


6 


6 


6 




6 


23 


5 


8 


6 


4 


4 




6 


23 


3 


8 


6 


4 


4 




3 


23 


17 


8 


17 


17 


8 




40 


23 



10 



10 



23 



14 



23 



23 



31 



23 



31 



19 

dcg\/lna^Tab-B1^nab 



TABLE E-1 

/ 

DIAGNOSTIC COST GROUPS BY DIAGNOSTIC CATEGORY, FOR ALTERNATIVE DCG MODELS 



EDCG 



EDGGP 



DXG 

143 

143.01 
143.02 
143.03 
143.04 
143.05 
143.06 
143.07 
143.08 
143.09 
143.10 
143.11 
143.12 
143.13 
143.14 
143.15 
143.16 
143.17 

P1 
P2 
P3 
P4 
P5 
P6 
P7 



LABEL 



HISTORY OF DISEASE/AFTERCARE/SCREENING 

Infectious disease contact/carrier 

vaccination, medical exam, other preventive 

history of malignant neoplasm 

history of mental disorder/other disease 

history of drug allergy/other health hazard 

family history of disease 

problems of internal organs/external sites 

elective surgery 

prothesis/other device fitting, adjustment 

other orthopedic aftercare 

aftercare 

donor 

household/family/other psychosocial circumstances 

care not delivered 

administrative/consultation 

screening for malignant neoplasm 

screening/observation/special exams 

emergency intubation/mechanical ventilation 

dialysis 

gastrostomy 

enterostomy 

tracheostomy 

amputation 

venous access port 







PIP 


NON-PIP 


PIP 


NON-PIP 


CONCURRENT CONCURRENT 


ADDCG 


PIPDCG 


EDCG 


EDCG 


EDCGP 
2(6) 


EDCGP 
2 


ADDCO PIPDCG 


i 


2(6) 


2 


1 14 


i 




1(6) 


1 


1(6) 


1 


14 


^ 




2(6) 


2 


2(6) 


2 


1 14 


i 




2(6) 


2 


2(6) 


2 


1 14 


1 




1(6) 


1 


1(6) 


1 


1 14 


1 




1(6) 


1 


1(6) 


1 


1 14 


i 




1(6) 


1 


1(6) 


1 


2 14 


i 




2(6) 


2 


2(6) 


2 


3 14 


5 




4(6) 


4 


4(6) 


4 


3 14 


1 




1(6) 


1 


2(6) 


2 


3 14 


1 




1(6) 


1 


1(6) 


1 


1 14 


3 




4(6) 


4 


4(6) 


4 


14 14 


1 




1(6) 


1 


1(6) 


1 


3 14 


3 




4(6) 


4 


4(6) 


4 


3 14 


1 




1(6) 


1 


1(6) 


1 


1 14 


1 




1(6) 


1 


1(6) 


1 


14 


1 


6 


1(6) 


1 


1(6) 

6 
31 
17 
14 
31 
14 
20 


1 

6 
31 
17 
14 
31 
14 
20 


1 14 



■ No DCG assignment was made by the sorting algorlttim. All beneficiaries In the sample with a diagnosis In this DXG also had a higher cost diagnosis In another DXG wHch caused assignment to that DXG. 

NOTE; Numbers In parentheses are the DCG assignment generated by the sorting algorithm. The PIP EDGGs and PIP EDCGPs tor DXG1 43 were judged by the physician consultant team to be higWy 
discretionary with regard to the decision to admit to the hospital and were thus reassigned to be equal to the NON-PIP EDCG(P). The remainder of the DCG reasslgnments 
were made because the sorting algorithm assignment was based on a low frequency of cases. The reassignment was made to bring the DCG In line with Ihe average for the DXG. 

SOURCE: 1991 and 1992 Medicare claims. 



20 

dcg\l1na^Tab-e1Vlab 



APPENDIX F: 

PROSPECTIVE HIERARCHICAL 
COEXISTING CONDITION MODELS 



TABLE F-1 

PROSPECTIVE HIERARCHICAL COEXISTING CONDITIONS (HCCs) 



HOC 



HOSPITAL AND PHYSICIAN DIAGNOSES 

1 High Cost Infectious Disease 

2.01 septicemia/shock 

3.01 HIV/AIDS (including pneumocytosis) 

2 Moderate Cost Infectious Diseases 

1.01 central nervous system infection (e.g., meningitis, encephalitis) 

4.04 tutierculosis 

4.07 bacterial Infection in other diseases 

4.14 thnjsh 

3 Other Infectious Disease 

4.02 viral enteritis (intestinal infections) 

4.03 other intestinal infections 

4.05 strep throat/scarlet fever 

4.06 other bacterial infections 

4.08 herpes zoster (shingles) 

4.09 herpes simplex 

4.10 viral hepatitis 

4.11 other viral infections 

4.12 late syphilis, symptomatic 

4.13 dermatophyfosis (fungal skin infections, e.g., athlete's foot) 

4.15 mycoses (fungal diseases), miscellaneous 

4.16 other infections 

5.01 infection late effects 

4 Metastatic Cancer 

19.01 secondary cancer of lymph node 

19.02 secondary cancer of respiratory and digestive systems 

19.03 secondary cancer of other site 

19.04 disseminated cancer 

5 High Cost Cancers 

6.02 cancer of pharynx 
7.01 cancer of esophagus 

7.04 cancer of liver 

7.05 cancer of pancreas 

10.01 lung cancer 

12.02 multiple myeloma 
12-04 myeloid leukemia 

6 Moderate Cost Cancers 

6.01 cancer of mouth/tongue 

6.03 cancer of larynx 

6.04 other respiratory/intrathoracic cancer 

7.02 cancer of stomach 

7.03 cancer of small bowel/peritoneum 

7.06 other, unspecified cancer of digestive organs/peritoneum 
12.01 lymphoma/Karposi's sarcoma/Hodgkin's Disease 

12.03 lymphoid leukemia 

12.05 other leukemia 

14.01 cancer of ovaries/placenta/uterine adnexia 

16.01 cancer of bladder/kidney/urinary organs 

17.02 cancer of the brain/nervous system/pituitary, pineal glands 
18.01 cancer of bone and articular cartilage 

7 Lower Cost Cancers 

8.01 colon cancer 

9.01 rectal cancer 

11.01 breast cancer 

13.01 cancer of uterus 

13.02 cancer of cervix/female genital organs 
15.01 prostate cancer 



ADDCO 



10 
10 



HCC 
Hierarchy 



Hierarchy Rule 



STATUS FOR 
PAYMENT MODEL 

Basic Augmented 



15.02 cancer of lestis/male genital organs 



6 
14 
10 
5 



10 
14 
14 
10 
10 
6 
10 



None 



None 



None 



Out 



Out 



Out 



Neoplasm 



Neoplasm 



If in HCC 4 cannot be in HCC 5. 



Neoplasm 



If in HCC 4 or 5 cannot be in 
HCC 6. 



Neoplasm 



If in HCC 4 or 5 or 6 cannot be in 
HCC 7. 



dcg\/inaMab-f1Viab 



TABLE F-1 j 

PROSPECTIVE HIERARCHICAL COEXISTWG CONDITIONS (HCCs) 



HCC 

7 Lower Cost Cancers (continued) 

17.01 cancer of the eye 

18.02 cancer of connective and cdher soft tissue 

18.03 melanoma 

18.05 thyroid/endocrine cancer 

18.06 ottier/ill-defined site cancer 

8 Carcinoma In Situ 

21 .01 carcinoma in situ of digestive organs 

21.02 carcinoma in situ of respiratory system 

21 .03 carcinoma in situ of other sites, except skin 

9 Uncertain Neoplasm 

21.04 neoplasm of uncertain behavior, specified sites 

21.05 neoplasm of uncertain tiehaviornec/nos 

21.06 unspecified neoplasm 

10 Skin Cancer, except Melanoma 

18.04 skin cancer, except melanoma, including lip 

11 Benign Neoplasm 

17.03 benign neoplasm brain/nervous system/pituitary, 
pineal glands 

20.01 benign neoplasm of digestive system 

20.02 benign neoplasm of respiratory system 

20.03 benign neoplasm oT skin 

20.04 benign neoplasm of breast/other breast disorders 
20 05 benign neoplasm of urinary tract 

20.06 benign neoplasm of eye 

20.07 other benign neoplasms 

12 High Cost Diabetes 

24.01 diabetes with renal manifestalkjn 

24.02 diabetes with other specified complications 
25.01 hypoglycemic coma 

13 Lower Cost Diabetes 

22.01 diabetes without complications 
23.01 diabetes with acute complications 

24.03 diabetes with unspecified complications 

93.01 diabetic retinopathy 

93.02 proliferative diabetic retinopattiy 

14 Protein-Calorie Malnutrition 

27.09 protein-cakxie malnutritkjn 

15 Other Higher Cost Endocrine, Metabolic, Nutritional 
Disorders 

26.01 disorders of fluid/electrolyte/acid-base balance 

27.04 adrenal gland disorders, e.g.. Cushing's syndrome 

27. 12 disorders of plasma protein metabolism 

16 Other Lower Cost Endocrine, Metabolic, Nutritional 
Disorders 

25.02 other hypoglycemia 

27.01 goiter 

27.02 thyrotoxicosis, including Graves' disease 

27.03 thyroid disorders 

27.05 ovarian dysfunction 

27.06 testicular dysfunction 

27.07 other endocrine disorders 

27.08 pituitary/paralhyroid/thymus/polyglandular disorders 

27.10 vitamin/other nutritional deficiencies (e.g., rickets, scurvy) 

27.11 disorders of lipoid metatxilism (high cholesterol) 

27.13 disorders of mineral metabolism 

27.14 metabolism disorders, nec/nos 

27.15 other hyperalimentation 

27.16 obesity/localized adiposity 



ADDCG 



HCC 
Hierarchy 



Hierarchy Rule 



STATUS FOR 
PAYMENT MODEL 

Basic Augmented 



10 
8 
10 



10 



Neoplasm 



Neoplasm 



Neoplasm 



Neoplasm 



If in HCC 4 or 5 or 6 or 7 then 
cannot be in HCC 8. 



If in HCC 4 or 5 or 6 or 7 or 8 
then cannot be in HCC 9. 



If in HCC 4 or 5 or 6 or 7 or 8 or 9 then 
cannot be in HCC 10. 

If in HCC 4 or 5 or 6 or 7 or 8 or 9 or 10 
then cannot be in HCC 11. 



Out 



Out 



Out 



Out 



Out 



Out 



Out 



Diabetes 



Diabetes 



If in HCC 12 then cannot be 
in HCC 13. 



None 



None 



None 



Out 



Out 



Out 



Out 



dcg^finai\Tat>-f1^nab 



TABLE F-1 

PROSPECTIVE HIERARCHICAL COEXISTING CONDITIONS (HCCs) 



HCC 

17 Liver Disease 

29.01 end stage liver disorders 

29.02 esophageal varices 

30.01 cirrhosis 

18 High Cost Gastrointestinal Disoixten 

28.02 chronic pancreatitis/other pancreatic diseases/intestinal malabsorption 
32.02 ulcer with perforation 

37.01 regional enteritis (Crohn's disease) 

37.02 ulcerative colitis 

38.01 intestinal otistaiction 

38.02 peritonitis 

19 l\Ioderate Cost Gastrointestinal Disorders 

4.01 bacterial enteritis (intestinal infections) 

28.01 acute pancreatitis 

30.02 other liver disorders, including toxic hepatitis 
32.01 ulcer vflthout perforation 

33.01 pyloric/duodenal obstruction 

34.01 appendicitis 

35.01 abdominal hernia, complicated 

38.03 other peritoneal disorders 

40.03 intestinal atxiess/ulceration/perforation 

41.01 cholelithiasis (gallstones) 

41 .02 biliary tract disease 

41.03 other oalU]ladiler.disonlers 
42.01 gastrointestinal hemorrhage 

20 Lower Cost Gastrointestinal Disorders 

31.01 disease of esophagus 

33.02 gastritis/other gastric disorder (stomach disorders) 
36.01 abdominal hernia/uncomplicated 

39.01 divercula of intestine 

40.01 hemorrhoids 

40.02 anal/rectal disorders 

40.04 other intestinal disorders 



ADDCG 



14 
14 

5 



HCC 
Hierarchy 



Hierarchy Rule 



STATUS FOR 
PAYMENT MODEL 

Basic Augmented 



None 



Gastrointestinal 



Gastrointestinal 



If in HCC 18 then cannot be 
in HCC 19 



Out 



Gastrointestinal 



If in HCC 18 or 19 then cannot 
be in HCC 20. 



Out 



Out 



21 Bone and Joint Infections 

45.01 arthropathy with infection 

45.02 osteomyelitis 

22 Rheumatoid Arthritis and Connective Tissue Disease 

44.01 systemic lupus erythematosus, scleroderma, and other 
connective tissue disease 

44.02 rheumatoid aitfirltis and 

other inflammatory polyarthropattiy 

23 Other Muscuioslteletal and Connective Tissue Disorders 

43.01 gout/crystal arthropathy 

43.02 other arthropathy/joint disorders, derangements, joint pain/stifTness 

44.03 inflammatory spondylopathies 

44.04 polymyalgia rheumatica 
46.01 osteoarthritis 

47.01 back disorders (e.g.. herniated disc, lumbago, sciatica, 

backache) 

48.01 disorders of soft tissue (e.g., tendonitis, bursitis) 

49.01 osteoporosis 

49.02 other bone disorders (e.g.. cuivature of spine, Pagef s disease) 

49.03 flat foot, acquired defomiities of toe 

49.04 other acquired limb deformities 

1 19.04 congenital anomalies of musculoskeletal/limb 

24 Aplastic and Acquired Hemolytic Anemias 

51.02 acquired hemolytic anemia 

51.03 aplastic anemia 



10 
14 



None 



Musculoskeletal 



Musculoskeletal 



If in HCC 22 then cannot be 
in HCC 23. 



Out 



Out 



Hematological 



dcg^rlna^Tal>•f1Vwb 



TABLE F-1 I 

PROSPECTIVE HIERARCHICAL COEXISTING CONDITIONS (HCCs) 



HCC 

25 Blood/Immune Disorders 

51.01 sickle cell and other hereditary hemolytic anemias 

51 .04 hemophilia and other coagulation defects 

51 .05 purpuraAhromtJOcytopathy/hemontiagic conditions 

51.06 white blood cell disorders 

51.07 immune disorders 

26 Iron Deficiency and Other/Unspecified Anemias 

50.01 iron deficiency and other/unspecified anemias 

51.08 other blood disease 



ADDCG 



HCC 
Hlerarcliv 

Hematological 



Hematological 



Hierarchy Rule 

If in HCC 24 then cannot be 
in HCC 25. 



If in HCC 24 or 25 then cannot 
be in HCC 26. 



STATUS FOR 
PAYIVIENT MODEL 

Basic Augmented 



Out 



Out 



27 Dementia 

52.01 senile/presenile psychoses 

52.02 other organic psychotic conditions 

52.03 cerebral degeneration/Alzheimer's disease 

52.04 senility without psychosis 

28 Drug/Alcohol Dependence/Psychoses 

53.01 alcoholic psychoses 

53.02 drug psychoses 

59.01 alcohol dependence 

59.02 drug dependence 

29 Higher Cost (Mental Disorders 

54.01 delirium/delusions/hallucinations 

54.02 hallucinations, symptomatic 
55.01 schizophrenic disorders 

56.01 manic and depressive disorders, including major depressive disorder 

57.01 paranoid states 

57.02 other nonorganic psychoses 
60.01 personality disorders 

1 34. 04 attempted suicide/self-inflicted injury 

30 Lower Cost Mental Disorders 

58.01 neurotic disorders (e.g. anxiety, panic attack, phobias) 

59.03 non-dependent abuse of drugs 

60.02 sexual deviations and disorders 

60.03 psychophysiologic disorders 

60.04 acute reaction to stress 

60.05 adjustment reaction 

60.06 nonpsychotic organic brain syndrome 

60.07 depression, not elsewhere classified 

60.08 behavior disorder 

60.09 developmental behavioral disorders 

60. 1 mental retardation 

60. 1 1 other mental disorders 



None 



Mental Disorders 



Out 



Out 



Mental Disorders If in HCC 28 then cannot 
8 be in HCC 29. 

5 
3 
5 
5 
5 
6 
10 



Mental Disorders If in HCC 28 or 29 then cannot 
be in HCC 30. 



Out 



Out 



31 Quadrlplegla/Paraplegia 

63.03 quadriplegia 
63-04 paraplegia 

32 Higher Cost Neurological Disorders 

62.01 Parkinson's Disease 

62.02 Huntington's Disease, essential tremor, other abnormal movement disorders 

62.03 anterior hom cell disease, including Lou Gehrig's Disease (ALS) 

62.04 other spinal cord disease 

62.05 autonomic nerve disorder 

62.06 Tay-Sachs, other hereditary and degenerative 
central nervous system diseases 

63 01 multiple sclerosis, other central nervous system dymelination 

63.05 Cauda equina syndrome 

63.06 other paralytic disorders 

63.08 other central nervous system disorders 

64.01 epilepsy and other seizure disorders/convulsions 

66.01 peripheral neuropathy 



10 

10 



Nervous System 



Nervous System 



If in HCC 31 then cannot 
be in HCC 32. 



dcgVina!\Tab-riViab 



TABLE F-1 

PROSPECTIVE HIERARCHICAL COEXISTING CONDITIONS (HCCs) 



HCC 



32 HIgherCost Neurological Disorders (continued) 

66.02 inflammatory/toxic neuropattiy. including Guillain-Ban'e Syndrome 

66.03 myoneural disorders/myasthenia gravis 

66.04 muscular dystrophies 

67.01 cerebral cysts, compression, edema, anoxic damage, 
other brain conditions 

95.05 paralysis of vocal cords/larynx 

119.01 spina bifida, other congenital anomalies of nervous system 

33 Lower Cost Neurological Disord«fs 

63.02 infantile cerebral palsy 

65.01 trigeminal nerve disorders 

65.02 facial nerve disorders, including Bell's Palsy 

65.03 root/plexus disorders 

65.04 root/plexus lesions 

65.05 other cranial nerve disorders 

65.06 neuropathy of upper limb (e.g., carpal tunnel syndrome) 

65.07 neuropathy of leg 
66.05 other neuropathy 

34 Respiratory Arrest 

105.02 respiratory arrest 

35 Heart Arrest/Shock 

79.01 heart arrest/shock 

36 Respiratory Failure 

105.01 respiratory failure 

104.03 acute lung edema nos 

104.04 post trauma/surgery pulmonary insufficiency 

37 Congestive Heart Failure 

75.01 pulmonary embolism (Wood clot) 

75.02 other pulmonary heart disease 
80.01 heart failure 

81.03 cardiomyopathy/myocarditis 

38 Heart Arrhythmia 

77.01 atrial arrhythmia 
78.01 ventric tachycardia 

39 Valvular and Rheumatic Heart IJisease 

68.01 rheumatic fever/heart disease 

68 02 mitral or aortic valve/endocardia disease 
68. 03 mitral/aortic valve disorders 

81.02 acute endo/myocafditis 

40 Coronary Artery Disease 

71.01 myocardial infarction 

71.02 old myocardial infarction 

71 .03 other chronic ischemic heart disease 
72.01 acute myocardial infarction (heart attack) 
73.01 other acute ischemia 

74.01 angina pectoris 

41 Other Heart Disorders 

76.01 conduction disorders/cardiac dysrhythmias 

81.01 pericarditis, post-MI 

119.03 congenital anomalies of cardiac/circulatory systems 

42 Hypertensive Heart Disease 

69.02 hypertensive heart disease 

70.02 malignant hypertensive heart disease 

70.03 hypertensive heart and renal disease 
70.05 hypertension encephalopathy 

43 Heart Disease, IVIIscellaneous 

76.02 premature heart beats 

81.04 cardiomegaly (enlarged heart) 

81.05 other heart disease 





HCC 
Hierarchy Hierarchy Rule 


STATUS FOR 
PAYfrtENT MODEL 


ADDCG 


Basic Auamented 


6 
3 
8 
S 






7 
5 






1 
2 
1 
1 
2 
1 
1 
1 
1 


Nervous System If in HCC 31 or 32 then cannot 
be in HCC 33. 


Out Out 


17 


Cardio-Respiratory 
Anest 





7 
14 
8 



Cardio-Respiratory If in HCC 34 then cannot also 

Arrest be in HCC 35. 

Cardio-Respiratory If in HCC 34 or 35 then cannot 

Arrest also be in HCC 36. 



Heart 



Heart 



Heart 



Heart 



It in 37 then cannot 
be in HCC 38. 



If in HCC 37 or 38 then cannot 
be in HCC 39. 



If in HCC 37 or 38 then 
cannot be in HCC 40. 



Heart 



Heart 



Heart 



If in HCC 37 or 38 or 39 or 40 
then cannot be in HCC 41 . 



If in HCC 37 or 38 or 39 or 40 
or 41 then cannot be in HCC 42 



If in HCC 37 or 38 or 39 or 40 or 41 
or 42 then cannot be in HCC 43, 



Out 



Out 



Out 



Out 



Out 



Out 



dcg\rinaATatj-f1\nab 



TABLE F-1 

PROSPECTIVE HIERARCHICAL COEXISTING CONDITIONS (HCCs) 



STATUS FOR 
PAYMENT MODEL 



HOC 

44 Hypertension (High Blood Pressure) 

69.01 essential hypertension 
70.01 malignant hypertension 

70.04 secondary hypertension 

45 Cerebrovascular Disease (Stroke) 

5.02 cerebrovascular disease late effects 

82.01 ceretiral hemon-hage 

83.01 precerebral arterial occlusion 

84.01 cerebrovascular accident (stroke) 

84.02 hemiplegia (paralysis of one side of body) 

84.03 aphasia (toss of language skills/comprehension) 
85.01 transient cerebral ischemia 

46 Vascular Disease 

86.01 atherosclerosis/arteriosclerosis of major vessel 

86.02 atherosclerosis/general, arteriosclerotic cardiovascular disease, 
arteriosclerosis/general 

87.01 aortic aneurysm 

87.02 other aneurysm 

88.01 arterial embolism and thrombosis (blood clots) 

89.01 specified peripheral vascular disease 

89.03 peripheral vascular disease 
89 04 other arterial disease 

89.06 vascular insufficiency of intestines 

89.07 gangrene 

47 Other Circulatory Disease 

89.02 Raynaud's syndrome 

89.05 disease of capillaries 

90.01 phlebitis and thrombophlebitis 

90.02 noninfectious lymphatic disorders 

90.03 hemorrhage nos 

90.04 compression of vein 

91.01 hypotension (low blood pressure) 

92.01 superficial phlebitis-leg 

92.02 varicose veins 

92.03 other circulatory disease/postphlebitic syndrome 

92.04 other specified circulatory disorders 

48 Chronic Obstructive Pulmonary Disease 

96.01 emphysema/Chronic t>ronchitis 
101.01 asthma 

49 Higher Cost Pneumonia 

99.01 gram-negative/staphylococcus pneumonia 

100.01 pneumococcal and other specific bacterial pneumonia 

102.02 aspiration pneumonia 

104.01 empyema/abscess of lung 

50 Lower Cost Pneumonia 

98.01 viral pneumonia 

100.02 other and unspecified pneumonia 

51 Pleurisy/Fibrosis of Lungs 

102.01 bronchiectasis/lung diseases due to specified 
external agents (e.g., black lung disease) 

102.03 respiratory conditions due to other and unspecified 
external agents/postinflammalory fibrosis 

103.01 pleurisy/pneumothorax (collapsed lung) 

52 Other Lung Disease 

97.01 other bronchitis 

98.02 influenza 

104.02 pulmonary congestion/hypostasis 
1 04.05 other lung disease 





HCC 








ADDCG 


Hierarchy 


Hierarchy Rule 


Basic 


Auamented 




Heart 


If in HCC 37 or 38 or 39 or 40 or 41 


Out 


Out 


1 




or 42 or 43 then cannot be in HCC 44. 






1 










1 










5 










5 










3 










5 










8 










8 










3 


Vascular 








5 










3 










5 










5 










7 










5 










5 










5 










7 










12 












Vascular 


If in HCC 46 then cannot 


Out 


Out 


1 




be in HCC 47. 






1 










1 










3 










1 










1 










3 










3 










1 










5 










3 


Lung 








3 










3 


Lung 








10 










5 










14 










8 












Lung 


If in HCC 49 then cannot be 


Out 




3 




in HCC 50. 






3 












Lung 


If in HCC 48 or 49 or 50 then cannot 


Out 




3 




be in HCC 51. 






3 










3 












Lung 


If in HCC 48 or 49 or 50 or 51 then 


Out 


Out 


1 




cannot be in HCC 52. 






1 










3 










3 











dcg\fina(\Tab-f1Viab 



TABLE F-1 

PROSPECTIVE HIERARCHICAL COEXISTING CONDITIONS (HCCs) 



HCC 



53 Eye, Ear, Nose, and Throat Disorders 

93 03 endophthalmitis (eye inflammation) 

93.04 retinal disorders 

93.05 glaucoma 

93.06 cataract/lens replacement 

93.07 disorders of refraction and accommodation 
(e.g.. far-, near-sightedness, astigmatism) 

93.08 vitreous hemon'hage 

93.09 other eye disorders 

94.01 impacted earwax 

94.02 otitis media (middle ear infection) 

94.03 vertiginous syndromes (e.g., vertigo. Meniere's Disease) 

94.04 hearing loss 

94.05 other ear disorders 

95.01 acute nose/throat infection (e.g., cotmnon cold) 

95.02 nasal polyps/allergic rhinitis (e.g.. hay fever) 

95.03 chronic sinusitis 

95.04 larynx/vocal cord diseases 

95.06 disorders of teeth, gum. and jaw (e.g.. gingivitis, periodontitis) 

95.07 other diseases of upper respiratory system 

95.08 salivary gland diseases 

95.09 other oral soft tissuertongue/jaw disorders 
1 19.02 congenital anomalies of eye 

54 Renal Failure 

106.01 nephritis, dialysis encounter 

106.02 acute renal failure 

106.03 chronic renal failure 

106.04 renal failure, unspecified 

55 Other Urinary Track Disorders 

106.05 impaired renal function 
107.01 kidney infection 

108.01 renal/ureteral/bladder cateulus (e.g.. kidney stones) 

109.01 urethral stricture 

109.02 hydronephrosis/other renal/urethral disorders 
1 10.01 cystitis, other urinary tract infections 
111.01 other urinary disorders 

56 Genital Disorders 

112.01 hyperplasia of prostate 

1 12.02 other prostatic disorders 

1 1 2.03 penis/lestis/male genital organs disorders 

1 13.01 diseases of female pelvic organs 

1 13.02 vaginal and cervical diseases 

1 13.03 other diseases of female genital organs 

113.04 female stress incontinence 

113.05 menopausal and postmenopausal disorders 
114.01 genital prolapse 

57 Pregnancy/Perinatal Conditions 

115.01 pregnancy/birth complications, mother/child 

11 5. 02 pregnancy with abortive outcome 

115.03 normal pregnancy/delivery 

58 Chronic Ulcer of Skin 

1 17.01 chronk; ulcer of skin 

59 Other Dermatologlcal Disorders 

1 16.01 cellulitis/abscess/other local skin infection 

116 02 bullous dermatoses 

118.01 dematitis due to substances taken internally (e.g., food, drugs) 

118.02 psoriasis and similar disorders 

1 1 8. 03 other dermatosis 

1 1 8. 04 diseases of nail (e.g., ingrown toenail) 

1 18.05 other dermatologlcal disorders 



ADDCG 



HCC 
Hierarchy 



Hierarchy Rule 



1 19.05 congenital anomalies of skin 



None 



STATUS FOR 
PAYMENT MODEL 

Basic Augmented 

Out Out 



Urinary 



Urinary 



If in HCC 54 then cannot 
be in HCC 55. 



Out 



Cut 



None 



Out 



Out 



None 



Skin 



Skin 



Out 



Out 



if in HCC 58 then cannot 
be in HCC 59. 



Out 



OU 



dcg\fina^Tab-f1^nab 



TABLE F-1 I 

PROSPECTIVE HIERARCHICAL COEXISTING CONDITIONS (HCCs) 



HCC 

60 Hip and Vertebral Fractures 

126.01 vertebral fracture without spinal cord injury 

126.02 vertebral fracture vinth spinal cord injury 
128,01 pelvic fracture 

129.01 femoral fracture 

61 Higher Cost Injuries and Poisonings 

131.02 dislocation of flip 

1 31 .03 dislocation of knee, including cartilage/meniscus tear 

132.02 injury to fieart/lung/intrattioracic organs/blood vessels of ttiorax 

132.03 gastrointestinal/lrver/kidney/spleen/pelvis injury 
132.07 traumatic amputation of leg/hand/Toot/toe 
135.01 intracranial (head) injury 

136.01 third degree bums 

137.01 accidental poisoning by prescription or over-the-counter 

medications/biological sutjstances, including medication errors 

62 Lower Cost Injuries and Poisonings 

5.03 injury late effects 

127.01 fractures of skull/face 

127.02 fractures of nasal tione 

130.01 fractures of lower limb (e.g., leg, ankle, foot) 

131.01 shoulder dislocation 

131. 04 otherdislocations 

131.05 fracture of rib, closed 

131.06 hand/wrist/lower arm fracture 

131.07 other fractures 

132.01 foreign body in pharynx/larynx 

1 32. 04 open wound of eye 

132.05 open wound/injury of lower arm 

132.06 open wound of other sites 

132.08 crushing injury 

132.09 foreign body in eye/ear/nose 
133.01 sprains 

134.01 concussion 

134.02 contusion/superTicial injury 

134.03 accidental falls 
134.05 other accidents 
136.02 other burns 

136 03 nerve injury (including spinal cord injury without spinal bone injury) 

136.04 early complications of trauma 

137.02 poisoning by specified nonmedicinal substances/ 
injury by certain external causes 

137.03 poisoning by other nonmedicinal substances 

137.04 allergy, unspecified 

137.05 adverse effects of conectly prescribed and administered 
drugs in therapeutic use 

63 Complications of Medical and Suiglca! Care 

138.01 malfunction of internal orttmpedic device/grafl 

138.02 infection/inflammation due to internal device/graft, 
transplant failure/rejection 

1 38. 03 other complications of certain specified 
medical procedures 

138.04 other complications of medical and 

surgical procedures, nee (e.g., post-operative infection) 

138.05 misadventure or abnormal reaction/complication of patient 
during surgery or medical care 



ADDCG 



HCC 
Hieitircl^v 



Hierarchy Rule 



STATUS FOR 
PAYMENT MODEL 

Basic Augmented 



Injury 



Injury 



Injury 



If in HCC 60 or 61 then cannot 
be in HCC 62. 



Out 



Out 



None 



Out 



5 
14 

5 

3 

1 



64 Coma 

121.01 



coma 



65 Major Symptoms 

63.07 nervous/musculoskeletal system symptoms 
121.02 syncope (fainting) and collapse 
122.01 fever 

123.01 dyspnea (labored breathing)/other respiratory abnormalities 

123.02 tiemoptysis (coughing up blood) 



None 



None 



Out 



Out 



8 

dcgMinal\T8b-f 1 Viab 



TABLE F-1 

PROSPECTIVE HIERARCHICAL COEXISTING CONDITIONS (HCCs) 



liCC ADDCQ 

65 Major Symptoms (continued) 

123.04 respiratory/other chest symptoms 3 

124.01 cfiest pain 3 

125.01 retention of urine 5 

125.02 incontinence/uretfiral dischaTfle 3 
125.04 alxlominal/pelvis symptoms 3 

66 Minor Symptoms, Signs, Findings 

61.01 tieadaches. including migraine 

119.06 ctiromosomal anomalies 

1 19.07 ottier congenital anomalies 

120.01 somatic/segmental dysfunction 

120.02 dizziness and giddiness 

120.03 malaise and fatigue 

120.04 other general symptoms 
123.03 cough 

124.02 other cardiovascular symptoms 

125 03 other urinary system symptoms 

143.01 infectious disease cotitact/camer 

143.07 problems of internal organs/external sites 

143.13 household/family/other psychosocial circumstances 

143.14 care not delivered 3 

PROCEDURES. AND FACTORS INFLUENCING CONTACT WITH HEALTH SERVICES 

67 Heart Lung, Kidney, Liver Transplant 
P9 heart, lung, kidney, liver transplant 

68 Heart, Heart Valve, Kidney, Lung, Liver Transplant (status/history) 

139.01 kidney, heart, heart valve (human/animal tissue), 5 
lung, liver transplant 

69 Other Organ Transplant/Replacement 

139.02 other organ transplant 1 

139.03 heart, heart valve replacement by artificial device 4 

139.04 joint replacement 5 

139.05 other organ replacement 4 

70 Tracheostomy 

P5 tracheostomy 31 

71 Gastrostomy 

P3 gastrostomy 17 

72 Enterostomy 

P4 enterostomy 14 

73 Artificial Opening Status/Attention 

139.06 artificial opening status/attention 7 

74 Machine Dependence 

139.09 aspirator, respirator, other machine dependence 8 

PI intubation/mechanical ventilation 6 

75 Post-Surgical States/Aftercare/Rehabllltation Procedures 

139.07 postsurgical states, eye 5 

139.08 other postsurgical states, including dialysis status 3 
140.01 rehabilitation procedures 3 

143.08 elective surgery 3 

143.09 prothesis/other device fitting, adjustment 5 

143.10 other orthopedic aftercare 1 

143.11 aftercare 1 

143.12 donor 5 

76 Radiation Therapy 

141.01 radiation therapy 3 

PIG radiation oncology 

77 Venous Access Port 
P7 venous access port 20 



HOC 
Hierarchy 



Hierarchy Rule 



STATUS FOR 
PAYMENT MODEL 

Basic Augmented 



None 



Out Out 



If in HOC 67 cannot be in HCC 68 



Transplant 
Transplant 

None 



Artificial Opening, 
Tracheostomy 

Artificial Opening 
Artificial Opening 



Artificial Opening If in HCC 70 or 71 or 72 then 

cannot be in HCC 73 



Out 



Out 



Out Out 



Out 



Tracheostomy 



None 



If in HCC 70 then cannot be in 
HCC 74. 



Out 



Out 



Out 



Out 



Out 



Out 



Chemo-/ 
Radio-Therapy 

None 



If in HCC 78, then cannot be in 
HCC 76. 



Out Out 



Out 



dcg\finaI\Tab-f1\nab 



TABLE F-1 I 

PROSPECTIVE HIERARCHICAL COEXISTING CONDITIONS (HCCs) 



HCC 



HCC 
ADDCG Hierarchy 



Hierarchy Rule 



STATUS FOR 
PAYMENT MODEL 

Basic Augmented 



78 Chemotherapy 

142.01 chemotherapy 
P8 chemotherapy 

79 Dialysis 

P2 dialysis 

80 Major Surgical Amputations 

P6 major surgical amputations 

81 Preventive/Screening/Observation/Speciai Exams 

143.02 vaccination, medical exam, other preventive 

143.15 administrative/consultation 

143.16 screening for malignant neoplasm 

143.17 screening/ot)servation/specia1 exams 

82 History of Disease 

1 43.03 history of malignant neoplasm 

143.04 history of mental disorder/other disease 

143.05 history of daig allergy/other health hazard 

143.06 family history of disease 

PRINCIPAL HOSPITAL INPATIENT DIAGrjOSES* 

83 Very High Incremental Cost Principal Inpatient Diagnoses 

4 metastatic cancer 
17 iiver disease 

24 aplastic and acquired hemolytic anemias 
48 chronic obstructive pulmonary disease 

84 High Incremental Cost Principal Inpatient Diagnoses 

5 high cost cancers 

12 high cost diabetes 

25 blood/immune disorders 

28 drug/alcohol dependence/psychoses 

29 higher cost mental disorders 

36 respiratory failure 

37 congestive heart failure 

58 chronic ulcer of the skin 

85 Moderate Incremental Cost Principal Inpatient Diagnoses 

6 moderate cost cancers 

13 lower cost diabetes 

15 other higher cost endocrine, metabolic, nutritional disorders 

22 rheumatoid arthritis and connective tissue disease 

26 iron deficiency and other/unspecified anemias 
32 higher cost neurological disorders 

40 coronary artery disease 

42 hypertensive heart disease 

45 cerebrovascular disease 

52 other lung disease 

55 other urinary tract disorders 

59 other dermatological disorders 

86 Principal Inpatient Diagnosis of Chemotherapy 

78 chemotherapy 

87 All Other Principal Inpatient Diagnoses 



Chemo-/ 
10 Radio-Therapy 



31 



14 



None 



None 



None 



None 



Out 



Out 



Out 



Out Out 



Out 



Out 



Out 



Out 



Out 



Out 



Out 



Out Out 



10 
dcg^/tnal\Tab-f1^nab 



TABLE F-1 

PROSPECTIVE HIERARCHICAL COEXISTING CONDITIONS (HCCs) 



HCC 



OTHER RISK FACTORS 



ADDCQ 



HCC 
Hierarchy 



Hierarchy Rule 



STATUS FOR 
PAYMENT MODEL 

Basic Augmented 



Age/Sex 



Female: Younger than 65 
Female: 65-69 
Female: 70-74 
Female: 75-79 
Female: 80^ 
Female: 85 or older 
Male: Younser than 65 
Male: 65-69 
Male: 70-74 
Male: 75-79 
Male: 80^ 
Male: 85 or older 



Principal inpalienl HCCs are assjgned using Ihe same hierarcrtcal njles as are emptoyed tor al hospital and physician diagnosis HCCs. 
E.g.. someone wlh a principal inpatient diagnosis of metastatic cancef is excluded from the principal irpatiert HCC of hffi cost cancers. 



11 

dcg^fina^Tat}-r1^nab 



TABLE F-2 

HIERARCHICAL COEXISTING CONDITIONS, PROCEDURES AND HOSPITALIZATIONS, 
AND AUGMENTED HIERARCHICAL COEXISTING CONDITIONS, PAYMENT MODELS 



HOC 



LABEL 



Intercept 

1 High Cost Infectious Disease 

2 Moderate Cost Infectious Diseases 

3 Other Infectious Disease 

4 Metastatic Cancer 

5 High Cost Cancers 

6 Moderate Cost Cancers 

7 Lower Cost Cancers 

8 Carcinoma in Situ 

9 Uncertain Neoplasm 

1 Skin Cancer, except Melanoma 

11 Benign Neoplasm 

12 High Cost Diabetes 

1 3 Lower Cost Diabetes 

14 Protein-Calorie Malnutrition 

1 5 Other Higher Cost Endocrine, Metabolic, Nutritional Disorders 

16 Other Lower Cost Endocrine, Metabolic, Nutritional Disorders 

17 Liver Disease 

1 8 High Cost Gastrointestinal Disorders 

1 9 Moderate Cost Gastrointestinal Disorders 

20 Lower Cost Gastrointestinal Disorders 

21 Bone and Joint Infections 

22 Rheumatoid Arthritis and Connective Tissue Disease 

23 Other Musculoskeletal and Connective Tissue Disorders 

24 Aplastic and Acquired Hemolytic Anemias 

25 Blood/Immune Disorders 

26 Iron Deficiency and Other/Unspecified Anemias 

27 Dementia 

28 Drug/Alcohol Dependence/Psychoses 

29 Higher Cost Mental Disorders 



HCCPH 


1 PAYMENT MODEL 
(R^ -.0974 ) 


HCCA 


PAYMENT MODEL 
(R^ = .0880) 


COEFF 


STD. ERR 


T-STAT 


COEFF 


STD. ERR 


T-STAT 


1.113 
3,087 
1,248 


34 

131 

89 


32.42 
23.62 
14.00 


1,099 
3,578 
1,458 


34 

131 

89 


31.87 
27.31 
16.29 


3,867 

3,268 

1,738 

629 

460 


122 

139 

88 

57 

201 


31.64 
23.51 
19.79 
11.00 
2.29 


6,042 

4,041 

2,047 

822 

474 


115 

139 

88 

57 

202 


52.31 
29.11 
23.32 
14.43 
2.34 


3,600 
1,406 
2,369 


105 

38 

174 


34.33 
37.22 
13.63 


3,877 
1,422 
3,621 


105 

38 

170 


37.04 
37.45 
21.24 


3,506 

1,819 

729 


200 
82 
46 


17.52 
22.16 
15.70 


3,963 

2,042 

772 


201 
82 
47 


19.75 
24.87 
16.56 


1,680 
1,469 


155 
76 


10.80 
19.34 


1,872 
1,423 


156 
76 


12.00 
18.64 


4,256 
855 


244 
93 


17.47 
9.17 


5,263 
1,184 


244 
93 


21.55 
12.66 


1,273 
1,186 


151 
63 


8.45 
18.97 


2,330 
1,573 


149 
62 


15.63 
25.47 










1 
dcg\final\Tab-f2\nab 



TABLE F-2 

HIERARCHICAL COEXISTING CONDITIONS, PROCEDURES AND HOSPITALIZATIONS, 
AND AUGMENTED HIERARCHICAL COEXISTING CONDITIONS, PAYMENT MODELS 



HCCPH PAYMENT MODEL 



HCCA PAYMENT MODEL 



HOC 

30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 
51 
52 
53 
54 
55 
56 
57 
58 
59 



LABEL 



Lower Cost Mental Disorders 

Quadripiegia/Paraplegia 

Higher Cost Neurological Disorders 

Lower Cost Neurological Disorders 

Respiratory Arrest 

Heart Arrest/Shock 

Respiratory Failure 

Congestive Heart Failure 

Heart Arrhythmia 

Valvular and Rheumatic Heart Disease 

Coronary Artery Disease 

Other Heart Disorders 

Hypertensive Heart Disease 

Heart Disease, Miscellaneous 

Hypertension (High Blood Pressure) 

Cerebrovascular Disease (Stroke) 

Vascular Disease 

Other Circulatory Disease 

Chronic Obstructive Pulmonary Disease 

Higher Cost Pneumonia 

Lower Cost Pneumonia 

Pleurisy/Fibrosis of Lungs 

Other Lung Disease 

Eye, Ear, Nose, and Throat Disorders 

Renal Failure 

Other Urinary Track Disorders 

Genital Disorders 

Pregnancy/Perinatal Conditions 

Chronic Ulcer of Skin 

Other Dermatological Disorders 





(R^ 


=.0974 ) 






(R^ = 


: .0880) 




COEFF 


STD. ERR 


T-STAT 


COEFF 


STD. 


ERR 


T-STAT 


4,894 




282 


17.37 


5,319 




283 


18.79 


1,414 




52 


27.12 


1,478 




52 


28.21 


5,511 




234 


23.58 


8,967 




228 


39.37 


1,120 




215 


5.22 


1,538 




216 


7.14 


1,720 




84 


20.47 


2,514 




83 


30.11 


2,519 




47 


53.96 


2,869 




46 


62.24 


1,219 




71 


17.23 


1,215 




71 


17.10 


765 




80 


9.53 


743 




81 


9.22 


1,008 




37 


27.42 


979 




37 


26.49 



1,207 


47 


25.78 


1,190 


47 


25.30 


1,011 


40 


25.28 , 


1,030 


40 


25.65 


1,203 


40 


29.86 


1,446 


40 


36.12 


2,576 


127 


20.30 


3,038 


127 


23.89 


951 


63 


15.18 


1,148 


63 


18.27 


650 


104 


6.23 


891 


105 


8.51 



2,779 



2,335 



112 



83 



24.87 



28.20 



3,295 



2,518 



111 



83 



29.58 



30.40 



dcg\nnal\Tab-f2\nab 



TABLE F-2 

HIERARCHICAL COEXISTING CONDITIONS, PROCEDURES AND HOSPITALIZATIONS, 
AND AUGMENTED HIERARCHICAL COEXISTING CONDITIONS, PAYMENT MODELS 



HCCPH PAYMENT MODEL 



HCCA PAYMENT MODEL 



HCC 



LABEL 



60 Hip and Vertebral Fractures 

61 Higher Cost Injuries and Poisonings 

62 Lower Cost Injuries and Poisonings 

63 Complications of Medical and Surgical Care 

64 Coma 

65 Major Symptoms 

66 Minor Symptoms, Signs, Findings 

67 Heart, Lung, Kidney, Liver Transplant 

68 Heart, Heart Valve, Kidney, Lung, Liver Transplant (status/histo 

69 Other Organ Transplant/Replacement 

70 Tracheostomy 

71 Gastrostomy 

72 Enterostomy 

73 Artificial Opening Status/Attention 

74 Machine Dependence 

75 Post-Surgical States/Aftercare/Rehabilitation Procedures 

76 Radiation Therapy 

77 Venous Access Port 

78 Chemotherapy 

79 Dialysis 

80 Major Surgical Amputations 

81 Preventive/Screening/Observation/Special Exams 

82 History of Disease 

83 Very High Incremental Cost Principal Inpatient Diagnoses 

84 High Incremental Cost Principal Inpatient Diagnoses 

85 Moderate Incremental Cost Principal Inpatient Diagnoses 

86 Principal Inpatient Diagnosis of Chemotherapy 

87 All Other Principal Inpatient Diagnoses 





(R' =.0974 ) 






(R^ = 


: .0880) 




COEFF 


STD. ERR 


T-STAT 


COEFF 


STD. 


ERR 


T-STAT 


1,037 
973 


82 
86 


12.69 
11.31 


929 
1,117 




82 
86 


11.32 
13.00 


743 
1,308 


71 
215 


10.46 
6.09 


1,101 
1,560 




71 
216 


15.55 
7.23 


4,066 
1,204 


2.901 
493 


1.40 
2.44 


- 




- 




24,760 
5,196 
5,194 
2,267 
1,984 


582 
321 
549 
206 
123 


42.54 
16.20 
9.46 
10.99 
16.12 


- 




- 




6,481 

4,169 

16,583 

1,985 


463 
165 
791 
416 


13.99 

25.26 

20.98 

4.77 


- 




m 




5,726 
3,200 


153 
88 


37.38 
36.23 


- 




[ 





6,123 



696 



8.80 



dcg\rinal\Tab-f2\nab 



TABLE F-2 

HIERARCHICAL COEXISTING CONDITIONS, PROCEDURES AND HOSPITALIZATIONS, 
AND AUGMENTED HIERARCHICAL COEXISTING CONDITIONS, PAYMENT MODELS 



HOC 



LABEL 



AGE/SEX 

FEMALE, < 65 

FEMALE, 70-74 

FEMALE, 75-79 

FEMALE, 80-84 

FEMALE, 85 OR OLDER 

MALE, < 65 

MALE, 65-69 

MALE, 70-74 

MALE, 75-79 

MALE, 80-84 

MALE, 85 OR OLDER 



HCCPh 


1 PAYMENT MODEL 


HCCA 


PAYMENT MODEL 




(R^ = 


.0974 ) 






(R^ = 


■■ .0880 




COEFF 


STD 


.ERR 


T-STAT 


COEFF 


STD. 


ERR 


T-STAT 


573 




73 


7.80 


639 




74 


8.66 


258 




46 


5.62 


245 




46 


5.32 


669 




49 


13.79 


630 




49 


12.91 


1,000 




54 


18.54 


931 




54 


17.19 


1.136 




57 


20.05 


1,045 




57 


18.35 


229 




62 


3.71 


287 




62 


4.64 


376 




50 


7.51 


365 




50 


7.24 


697 




50 


13.98 


683 




50 


13.63 


1,155 




55 


20.82 


1,120 




56 


20.08 


1,362 




68 


20.12 


1,302 




68 


19.14 


1,770 




82 


21.48 


1,655 




83 


19.98 



SOURCE: 1991 (Diagnoses) and 1992 (Expenditures) Medicare claims 



dcg\final\Tab-f2\nab 



TABLE F-3 

HIERARCHICAL COEXISTING CONDITIONS CLASSIFICATION MODELS 



HOC 



LABEL 



Intercept 

1 High Cost Infectious Disease 

2 Moderate Cost Infectious Diseases 

3 Other Infectious Disease 

4 Metastatic Cancer 

5 High Cost Cancers 

6 Moderate Cost Cancers 

7 Lower Cost Cancers 

8 Carcinoma in Situ 

9 Uncertain Neoplasm 

10 Skin Cancer, except Melanoma 

11 Benign Neoplasm 

12 High Cost Diabetes 

13 Lower Cost Diabetes 

14 Protein-Calorie Malnutrition 

15 Other Higher Cost Endocrine, Metabolic, Nutritional Disorders 

16 Other Lower Cost Endocrine, Metabolic, Nutritional Disorders 

17 Liver Disease 

18 High Cost Gastrointestinal Disorders 

19 Moderate Cost Gastrointestinal Disorders 

20 Lower Cost Gastrointestinal Disorders 

21 Bone and Joint Infections 

22 Rheumatoid Arthritis and Connective Tissue Disease 

23 Other Musculoskeletal and Connective Tissue Disorders 

24 Aplastic and Acquired Hemolytic Anemias 

25 Blood/Immune Disorders 

26 Iron Deficiency and Other/Unspecified Anemias 

27 Dementia 

28 Drug/Alcohol Dependence/Psychoses 

29 Higher Cost Mental Disorders 

30 Lower Cost Mental Disorders 



HCCP CLASSIFICATION MODEL 


HCC CLASSIFICATION MODEL 




(R^ =.0972 ) 






(R^ = .0913) 




COEFF 


STD. ERR 


T-STAT 


COEFF 


STD. ERR 


T-STAT 


743 


39 


18.96 


754 


39 


19.33 


2,742 


131 


20.89 


3,256 


131 


24.79 


1,032 


90 


11.48 


1,087 


90 


12.05 


138 


39 


3.56 


128 


39 


3.30 


4,020 


124 


32.48 


5.669 


116 


48.85 


3,212 


140 


23.00 


3,764 


139 


27.09 


1,420 


89 


15.91 


1.774 


88 


20.06 


388 


60 


6.49 


625 


58 


10.76 


245 


202 


1.22 


266 


202 


1.32 


196 


68 


2.87 


196 


68 


2.88 


26 


81 


0.32 


57 


81 


0.70 


-210 


40 


-5.27 


-217 


40 


-5.47 


3.674 


105 


35.01 


3,690 


105 


35.20 


1,314 


38 


34.41 


1,312 


38 


34.26 


2,135 


175 


12.24 


3,282 


171 


19.19 


938 


55 


16.95 


996 


55 


17.95 


-294 


32 


-9.32 


-309 


32 


-9.76 


3,787 


200 


18.96 


3,763 


200 


18.78 


1,405 


84 


16.77 


1.608 


84 


19.23 


428 


49 


8.78 


448 


49 


9.18 


204 


36 


5.72 


217 


36 


6.09 


1,544 


156 


9.92 


1,673 


156 


10.72 


1,421 


78 


18.30 


1,410 


78 


18.12 


358 


28 


12.86 


354 


28 


12.72 


4,624 


244 


18.97 


5,102 


244 


20.90 


828 


94 


8.83 


1,038 


94 


11.05 


347 


46 


7.46 


374 


47 


8.03 


59 


71 


0.82 


48 


72 


0.67 


2,002 


149 


13.45 


2,021 


149 


13.54 


1,410 


63 


22.30 


1,376 


63 


21.69 


109 


53 


2.05 


104 


53 


1.95 










1 

dcg\nnal\Tab-f3\nab 



TABLE F-3 

HIERARCHICAL COEXISTING CONDITIONS CLASSIFICATION MODELS 



HCC 

31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 
51 
52 
53 
54 
55 
56 
57 
58 
59 
60 
61 



LABEL 



Quadriplegia/Paraplegia 

Higher Cost Neurological Disorders 

Lower Cost Neurological Disorders 

Respiratory Arrest 

Heart Arrest/Shock 

Respiratory Failure 

Congestive Heart Failure 

Heart Arrhythmia 

Valvular and Rheumatic Heart Disease 

Coronary Artery Disease 

Other Heart Disorders 

Hypertensive Heart Disease 

Heart Disease, Miscellaneous 

Hypertension (High Blood Pressure) 

Cerebrovascular Disease (Stroke) 

Vascular Disease 

Other Circulatory Disease 

Chronic Obstructive Pulmonary Disease 

Higher Cost Pneumonia 

Lower Cost Pneumonia 

Pleurisy/Fibrosis of Lungs 

Other Lung Disease 

Eye, Ear, Nose, and Throat Disorders 

Renal Failure 

Other Urinary Track Disorders 

Genital Disorders 

Pregnancy/Perinatal Conditions 

Chronic Ulcer of Skin 

Other Dermatological Disorders 

Hip and Vertebral Fractures 

Higher Cost Injuries and Poisonings 



MGCP Cl 


J\SSIFICATIOr 


4 MODEL 


HCC CLASSIFICATION MODEL 




(R^ =.0972 ) 






(R^ = .0913) 




COEFF 


STD. ERR 


T-STAT 


COEFF 


STD. ERR 


T-STAT 


4,591 


282 


16.27 


4,928 


283 


17.43 


1,198 


53 


22.73 


1.244 


53 


23.54 


328 


85 


3.86 


330 


85 


3.86 


6,458 


233 


27.69 


8,856 


227 


38.93 


1,065 


215 


4.96 


1.342 


215 


6.24 


2,034 


84 


24.33 


2,312 


84 


27.68 


2,591 


49 


52.84 


2,603 


49 


53.13 


996 


73 


13.73 


1,016 


73 


13.99 


605 


81 


7.47 


608 


81 


7.50 


844 


40 


21.36 


841 


40 


21.28 


309 


71 


4.34 


308 


71 


4.32 


302 


94 


3.22 


299 


94 


3.18 


477 


108 


4.42 


487 


108 


4.51 


91 


34 


2.68 


82 


34 


2.43 


952 


47 


20.08 


978 


48 


20.59 


847 


41 


20.78 


876 


41 


21.45 


247 


66 


3.77 


295 


66 


4.49 


1,253 


41 


30.80 


1,245 


41 


30.55 


2,402 


127 


18.86 


2,753 


127 


21.61 


862 


63 


13.66 


899 


63 


14.20 


511 


105 


4.88 


612 


105 


5.83 


158 


44 


3.61 


162 


44 


3.68 


-26 


26 


-1.01 


-29 


26 


-1.13 


2,749 


113 


24.37 


3,125 


112 


27.81 


397 


37 


10.84 


385 


37 


10.50 


-186 


35 


-5.23 


-197 


36 


-5.54 


733 


149 


4.92 


784 


150 


5.24 


2,378 


84 


28.32 


2,432 


84 


28.98 


205 


31 


6.60 


201 


31 


6.44 


651 


84 


7.80 


656 


83 


7.88 


862 


87 


9.94 


953 


87 


11.02 










z 

dcg\final\Tab-f3\nab 



TABLE F-3 

HIERARCHICAL COEXISTING CONDITIONS CLASSIFICATION MODELS 



HOC 



LABEL 



62 Lower Cost Injuries and Poisonings 

63 Complications of Medical and Surgical Care 

64 Coma 

65 Major Symptoms 

66 Minor Symptoms, Signs, Findings 

67 Heart, Lung, Kidney, Liver Transplant 

68 Heart, Heart Valve, Kidney, Lung, Liver Transplant (status/histo 

69 Other Organ Transplant/Replacement 

70 Tracheostomy 

71 Gastrostomy 

72 Enterostomy 

73 Artificial Opening Status/Attention 

74 Machine Dependence 

75 Post-Surgical States/Aftercare/Rehabilitation Procedures 

76 Radiation Therapy 

77 Venous Access Port 

78 Chemotherapy 

79 Dialysis 

80 Major Surgical Amputations 

81 Preventive/Screening/Observation/Special Exams 

82 History of Disease 

83 Very High Incremental Cost Principal Inpatient Diagnoses 

84 High Incremental Cost Principal Inpatient Diagnoses 

85 Moderate Incremental Cost Principal Inpatient Diagnoses 

86 Principal Inpatient Diagnosis of Chemotherapy 

87 All Other Principal Inpatient Diagnoses 



HCCP CLASSIFICATION MODEL 


HCC CLASSIFICATION MODEL 




(R^ =.0972 ) 






(R^ = 


.0913) 




COEFF 


STD. ERR 


T-STAT 


COEFF 


STD 


.ERR 


T-STAT 


247 


33 


7.53 


259 




33 


7.88 


356 


72 


4.92 


832 




71 


11.71 


1,099 


215 


5.11 


1,286 




216 


5.96 


635 


31 


20.41 


650 




31 


21.00 


208 


29 


7.14 


221 




29 


7.62 


5,185 


2,902 


1.79 


. 






. 


860 


495 


1.74 


. 






. 


492 


115 


4.29 


. 






. 


24,658 


582 


42.34 


. 






. 


4,983 


321 


15.51 


. 






. 


5,145 


549 


9.37 


. 






. 


2,107 


207 


10.20 


. 






- 


2,123 


130 


16.38 


- 






- 


350 


57 


6.10 


. 






. 


-187 


221 


-0.85 


. 






. 


7,089 


463 


15.32 


. 






. 


4,509 


163 


27.71 


. 






. 


16,667 


791 


21.08 


. 






. 


2,729 


416 


6,56 


- 




. 


. 


11 


28 


0.40 


- 




. 


. 





60 


0.00 


. 




. 


. 



dcg\final\Tab-f3\nab 



TABLE F-3 

HIERARCHICAL COEXISTING CONDITIONS CLASSIFICATION MODELS 



HOC 



HCCP CLASSIFICATION MODEL 
(R^ =.0972 ) 



HCC CLASSIFICATION MODEL 
(R' = .0913) 



LABEL 



COEFF STD. ERR T-STAT COEFF STD. ERR T-STAT 



AGE/SEX 

FEMALE, < 65 

FEMALE, 70-74 

FEMALE, 75-79 

FEMALE, 80-84 

FEMALE, 85 OR OLDER 

MALE, < 65 

MALE, 65-69 

MALE, 70-74 

MALE, 75-79 

MALE, 80-84 

MALE, 85 OR OLDER 



595 

207 

554 

822 

925 

369 

438 

725 

1.144 

1,304 

1,664 



74 
46 
49 
55 
58 
63 
51 
51 
56 
68 
83 



8.07 

4.50 
11.35 
15.08 
15.98 
5.89 
8.62 
14.31 
20.33 
19.05 
19.98 



586 

200 

531 

777 

860 

363 

438 

728 

1,135 

1,275 

1,585 



74 
46 
49 
55 
58 
63 
51 
51 
56 
69 
83 



7.92 

4.35 

10.84 

14.20 

14.82 

5.77 

8.60 

14.34 

20.11 

18.57 

18.98 



SOURCE; 1991 (Diagnoses) and 1992 (Expenditures) Medicare claims 



dcg\final\Tab-f3\nab 



TABLE F-4 

ESTIMATED PROSPECTIVE HCC PAYMENT MODEL PARAMETERS FOR AGED AND DISABLED SUBSAMPLES 







AGED SUBSAMPLE 


DISABLED SUBSAMPLE 


DIFFERENCE 




LABEL 


(R» = 


.0835) 


(R» = 


.1217) 


DISABLED-AGED 


HCC 


COEFF 


STD. ERR 
$35 


COEFF 


STD. ERR 
$62 


VALUE 


t-TEST 




INTERCEPT 


$1,192 


$953 


-$239 


-3.37 


1 


High Cost Infectious Disease 


3,888 


137 


6,169 


422 


2,282 


5.15 


4 


Metastatic Cancer 


6,297 


118 


7,066 


577 


770 


1.31 


5 


High Cost Cancers 


4,274 


143 


3,817 


559 


-457 


-0.79 


6 


Moderate Cost Cancers 


2,189 


90 


1,957 


374 


-232 


-0.60 


7 


Lower Cost Cancers 


902 


58 


1,370 


345 


468 


1.34 


12 


High Cost Diabetes 


3,850 


110 


4,327 


340 


477 


1.34 


13 


Lower Cost Diabetes 


1,441 


39 


1,455 


143 


14 


0.10 


14 


Protein-Calorie Malnutrition 


3,980 


177 


4,486 


630 


506 


0.77 


17 


Liver Disease 


4,022 


219 


5,262 


498 


1,239 


2.28 


18 


High Cost Gastrointestinal Disorders 


2,008 


85 


3.511 


275 


1,503 


5.22 


21 


Bone and Joint Infections 


1,850 


166 


3,422 


452 


1,572 


3.27 


22 


Rheumatoid Arthritis and Connective Tissue Disease 


1,498 


81 


1,640 


239 


141 


0.56 


24 


Aplastic and Acquired Hemolytic Anemias 


5,373 


252 


7,237 


981 


1,864 


1.84 


25 


Blood/immune Disorders 


1,202 


98 


2,445 


311 


1,243 


3.81 


28 


Drug/Alcohol Dependence/Psychoses 


1,271 


187 


4,270 


249 


2,998 


9.63 


29 


Higher Cost Mental Disorders 


1,350 


73 


2,528 


118 


1,178 


8.51 


31 


Quadriplegia/Paraplegia 


5,643 


434 


4,975 


380 


-668 


-1.16 


32 


Higher Cost Neurological Disorders 


1,594 


58 


1,414 


127 


-180 


-1.29 


34 


Respiratory Arrest 


9,040 


241 


10,869 


703 


1,830 


2.46 


35 


Heart Arrest/Shock 


1,663 


223 


3,259 


863 


1,596 


1.79 


36 


Respiratory Failure 


2,732 


87 


3,391 


294 


659 


2.15 


37 


Congestive Heart Failure 


3,066 


47 


3,426 


201 


360 


1.74 


38 


Heart Arrhythmia 


1,338 


72 


1,572 


433 


234 


0.53 


39 


Valvular and Rheumatic Heart Disease 


795 


83 


893 


334 


98 


0.29 


40 


Coronary Artery Disease 


1,036 


38 


1,222 


156 


186 


1.16 


45 


Cerebrovascular Disease (Stroke) 


1,278 


49 


1,391 


198 


113 


0.55 


46 


Vascular Disease 


1,110 


41 


1,534 


186 


425 


2.23 


48 


Chronic Obstructive Pulmonary Disease 


1,505 


41 


2,122 


142 


617 


4.18 


49 


Higher Cost Pneumonia 


2,908 


132 


3,372 


445 


464 


1.00 


54 


Renal Failure 


3,413 


115 


4,313 


428 


900 


2.03 


58 


Chronic Ulcer of Skin 


2,528 


86 


3,838 


292 


1,310 


4.31^ 
dcg\final\Tab-f4\nab 



TABLE F-4 

ESTIMATED PROSPECTIVE HCC PAYMENT MODEL PARAMETERS FOR AGED AND DISABLED SUBSAMPLES 



HCC 

60 

61 
64 



LABEL 



Hip and Vertebral Fractures 
Higher Cost Injuries and Poisonings 
Coma 

AGE/SEX 

FEMALE, < 65 

FEMALE, 70-74 

FEMALE, 75-79 

FEMALE, 80-84 

FEMALE, 85 OR OLDER 

MALE, < 65 

MALE, 65-69 

MALE, 70-74 

MALE, 75-79 

MALE, 80-84 

MALE, 85 OR OLDER 



AGED SUBSAMPLE 


DISABLED SUBSAMPLE 


DIFFERENCE 


(R' = 


.0835) 


(R^ = 


.1217) 


DISABLED-AGED 


COEFF 


STD. ERR 
84 


COEFF 


STD. ERR 
389 


VALUE 


t-TEST 


1,147 


1,263 


116 


0.29 


1,159 


92 


1,664 


235 


505 


2.00 


1.706 


230 


1,608 


632 


-98 


-0.15 


1,249 


274 


338 


86 






252 


46 


— 





_ 


... 


642 


49 


— 





■w 


.. 


948 


54 


— 


_ 


«M 


.» 


1,068 


57 


_ 





__ 


•w 


781 


231 


— 





_^ 


*• 


363 


50 


— 


— 


_ 


__ 


689 


50 


_ 





MW 


__ 


1,139 


56 


_ 





__ 


•a 


1,320 


68 


— 





_ 


^ 


1,693 


83 


_ 


, 


_ 


__ 



SOURCE: 1992 (expenditures) and 1991 (diagnoses) Medicare claims. 



dcg\flnal\Tab-f4\nab 



APPENDIX G: 
GEOGRAPHIC INPUT PRICE INDEX 



TABLE G-1 

ALTERNATIVE GEOGRAPHIC ADJUSTMENT FACTORS BY METROPOLITAN AREA: 

GEOGRAPHIC INPUT PRICE INDEX (GIPI) AND COMPONENTS, AND INDEXED MEDICARE CAPITATION PAYMENT (lAAPCC) 







COMPONENTS OF GIPI 












1996 MFS 








PPS 


1 =Large 


Geographic 






Metropolitan 




Hospital 


Urban 


Adjustment 






Area Code* 


Metropolitan Area 


Wage Index** 
0.906 


Area 


Factor*** 
0.907 


GIPI 


lAAPCC*"* 


0040 


Abilene, TX MSA 





0.929 


0.829 


0060 


Aguadilla, PR MSA 


0.478 





0.768 


0.666 


0.366 


0080 


Akron, OH PMSA 


0.931 





0.980 


0.958 


1.140 


0120 


Albany, GA MSA 


0.896 





0.933 


0.929 


0.876 


0160 


Albany-Schenectady-Troy, NY MSA 


0.875 





1.000 


0.933 


0.852 


0200 


Albuquerque, NM MSA 


0.940 





0.952 


0.957 


0.858 


0220 


Alexandria, LA MSA 


0.828 





0.915 


0.889 


0.936 


0240 


Allentown-Bettiieliem-Easton, PA MSA 


1.023 





0.987 


1.010 


1.093 


0280 


Altoona, PA MSA 


0.931 





0.910 


0,943 


0.900 


0320 


Amarillo, TX MSA 


0.838 





0,928 


0.897 


0,816 


0380 


Anchorage, Ai< MSA 


1.313 





1.131 


1.246 


1.050 


0440 


Ann Arbor, Ml PMSA 


1.275 





1.071 


1.163 


1.119 


0450 


Anniston, AL MSA 


0.802 





0.915 


0.874 


0.924 


0460 


Appleton-Oshkosh-Neenah, Wl MSA 


0.875 





0.956 


0.923 


0.715 


0470 


Arecibo, PR PMSA 


0.376 





0.780 


0.612 


0.345 


0480 


Asheville, NC MSA 


0.892 





0.914 


0.923 


0.784 


0500 


Athens, GA MSA 


0.881 





0.944 


0.923 


0.911 


0520 


Atlanta, GA MSA 


1.024 


1 


1.008 


1,017 


1.080 


0560 


Atlantic-Cape May, NJ PMSA 


1.073 





1.047 


1.050 


1.135 


0600 


Augusta-Aiken, GA-SC MSA 


0.866 





0.952 


0.918 


0.900 


0640 


Austin-San Marcos, TX MSA 


0.904 





0.977 


0.943 


0.834 


0680 


Bakersfieid, CA MSA 


1.095 





0.992 


1,049 


1.104 


0720 


Baltimore, MD PMSA 


0.996 


1 


1.030 


1,007 


1.236 


0733 


Bangor, ME NECMA 


0.963 





0.942 


0.967 


0.760 


0743 


Barnstable-Yarmouth, MA NECMA 


1.344 





1.061 


1.197 


0.990 


0760 


Baton Rouge, LA MSA 


0.860 





0,942 


0.912 


1.131 


0840 


Beaumont-Port Arthur, TX MSA 


0,871 





0,969 


0.924 


1.240 


0860 


Bellingham, WA MSA 


1.136 





0,975 


1.067 


0.772 


0870 


Benton Harbor, Ml MSA 


0.793 





0.990 


0.886 


0.886 


0875 


Bergen-Passaic, NJ PMSA 


1.139 


1 


1.115 


1.102 


1.038 


0880 


Billings, MT MSA 


0.880 





0.914 


0.917 


0.772 


0920 


Biloxi-Gulfport-Pascagoula, MS MSA 


0.804 





0.913 


0.875 


1.190 


0960 


Binghamton, NY MSA 


0.906 





0.958 


0.940 


0.830 


1000 


Birmingham, AL MSA 


0.879 





0.955 


0.925 


1.095 


1010 


Bismarck, ND MSA 


0.862 





0.903 


0.904 


0.858 


1020 


Bloomington, IN MSA 


0.830 





0.914 


0.889 


0.771 


1040 


Bloomington-Normal, IL MSA 


0.844 





0.936 


0.902 


0.719 


1080 


Boise City, ID MSA 


0.894 





0.927 


0.927 


0.701 


1123 


Boston-Worcester-Lawrence-Lowell-NECMA 


1.155 


1 


1.076 


1.102 


1.127 


1125 


Boulder-Longmont, CO PMSA 


0.971 





0.978 


0.979 


0,921 


1145 


Brazoria, TX PMSA 


0.858 





1.000 


0.924 


1.073 


1150 


Bremerton, WA PMSA 


0.971 





0.968 


0.977 


0.823 


1240 


Brownsville-Harlingen-San Benito, TX MSA 


0.831 





0.903 


0.887 


0,830 


1260 


Bryan-College Station, TX MSA 


0.865 





0.922 


0.910 


0,812 


1280 


Buffalo-Niagara Falls, NY MSA 


0.906 


1 


0.967 


0.944 


0,896 


1303 


Burlington, VT NECMA 


0.967 





0,978 


0.977 


0.832 


1310 


Caguas, PR PMSA 


0.437 





0.779 


0.646 


0.424 


1320 


Canton-Massillon, OH MSA 


0.861 





0.945 


0.913 


0.856 

1 

dcg\fi naI\Tab-g 1 \nab 



TABLE G-1 

ALTERNATIVE GEOGRAPHIC ADJUSTMENT FACTORS BY METROPOLITAN AREA: 

GEOGRAPHIC INPUT PRICE INDEX (GIPl) AND COMPONENTS, AND INDEXED MEDICARE CAPITATION PAYMENT (lAAPCC) 







COMPONENTS OF GIPl 












1996 MFS 








PPS 


1 =Large 


Geographic 






Metropolitan 




Hospital 


Urban 


Adjustment 






Area Code* 


Metropolitan Area 


Wage Index" 


Area 


Factor*** 


GIPl 


lAAPCC**** 


1350 


Casper, WY MSA 


0.849 





0.923 


0.901 


0.838 


1360 


Cedar Rapids, lA MSA 


0.859 





0.928 


0.908 


0.725 


1400 


Champaign-Urbana, IL MSA 


0.884 





0.932 


0.922 


0.709 


1440 


Charleston-North Charleston, SC MSA 


0.886 





0.923 


0.922 


0.858 


1480 


Charleston, WV MSA 


0.888 





0.947 


0.928 


0.936 


1520 


Charlotte-Gastonia-Rocl< Hill, NC-SC MSA 


0.941 


1 


0.947 


0.959 


0.834 


1540 


Charlottesville, VA MSA 


0.943 





0.970 


0.962 


0.890 


1560 


Chattanooga, TN-GA MSA 


0.902 





0.933 


0.933 


1.008 


1580 


Cheyenne, WY MSA 


0.755 





0.932 


0.853 


0.785 


1600 


Chicago, IL PMSA 


1.066 


1 


1.058 


1.051 


1.140 


1620 


Chico-Paradise, CA MSA 


1.044 





0.953 


1.013 


0.967 


1640 


Cincinnati, OH-KY-IN PMSA 


0.939 


1 


0.977 


0.964 


1.002 


1660 


Clarl<sville-Hopkinsville, TN-KY MSA 


0.751 





0.900 


0.844 


0.831 


1680 


Cleveland-Lorain-Elyria, OH PMSA 


0.968 


1 


0.997 


0.984 


1.131 


1720 


Colorado Springs, CO MSA 


0.921 





0.950 


0.946 


0.871 


1740 


Columbia, MO MSA 


0.922 





0.940 


0.945 


0.882 


1760 


Columbia, SC MSA 


0.901 





0.933 


0.932 


0.787 


1800 


Columbus, GA-AL MSA 


0.778 





0.925 


0.864 


0.793 


1840 


Columbus, OH MSA 


0.980 


1 


0.975 


0.986 


0.968 


1880 


Corpus Christi, TX MSA 


0.845 





0.939 


0.903 


1.022 


1900 


Cumberland, MD-WV MSA 


0.828 





0.922 


0.890 


1.116 


1920 


Dallas, TX PMSA 


0.950 


1 


0.996 


0.974 


1.059 


1950 


Danville, VA MSA 


0.798 





0.901 


0.869 


0.722 


1960 


Davenport-Moline-Rock Island, lA-lL MSA 


0.823 





0.927 


0.889 


0.792 


2000 


Dayton-SpringfieW, OH MSA 


0.929 





0.973 


0.956 


0.958 


2020 


Daytona Beacti, FL MSA 


0.843 





0.971 


0.909 


0.896 


2030 


Decatur, AL MSA 


0.814 





0.932 


0.885 


0.978 


2040 


Decatur, IL MSA 


0.785 





0.932 


0.869 


0.748 


2080 


Denver, CO PMSA 


1.051 


1 


0.990 


1.027 


1.013 


2120 


Des Moines, lA MSA 


0.875 





0.948 


0.921 


0.853 


2160 


Detroit, Ml PMSA 


1.084 


1 


1.133 


1.077 


1.352 


2180 


Dothan, AL MSA 


0.788 





0.909 


0.866 


0.987 


2190 


Dover, DE MSA 


0.921 





0.966 


0.950 


0.837 


2200 


Dubuque, lA MSA 


0.789 





0.910 


0.867 


0.691 


2240 


Duluth-Superior, MN-WI MSA 


0.922 





0.932 


0.943 


0.712 


2281 


Dutchess County, NY PMSA 


1.055 





1.058 


1.042 


0.958 


2290 


Eau Claire, Wl MSA 


0.843 





0.941 


0.902 


0.726 


2320 


El Paso, TX MSA 


0.852 





0.934 


0.906 


0.894 


2330 


Elkhart-Goshen, IN MSA 


0.858 





0.932 


0.909 


0.666 


2335 


Elmira, NY MSA 


0.853 





0.938 


0.907 


0.834 


2340 


Enid, OK MSA 


0.827 





0.887 


0.882 


0.779 


2360 


Erie, PA MSA 


0.906 





0.924 


0.933 


0.917 


2400 


Eugene-Springfield. OR MSA 


1.063 





0.944 


1.021 


0.739 


2440 


Evansville-Henderson, IN-KY MSA 


0.911 





0.913 


0.933 


0.829 


2520 


Fargo-Moorhead, ND-MN MSA 


0.916 





0.916 


0.936 


0.728 


2560 


Fayetteville, NC MSA 


0.850 





0.902 


0.897 


0.816 


2580 


Fayetteville-Springdale-Rogers, AR MSA 


0.692 





0.881 


0.807 


0.696 


2640 


Flint, Ml PMSA 


1.026 





1.038 


1.022 


1.334 

2 

<icg\final\Tab-g1\nab 



TABLE G-1 

ALTERNATIVE GEOGRAPHIC ADJUSTMENT FACTORS BY METROPOLITAN AREA: 

GEOGRAPHIC INPUT PRICE INDEX (GIPI) AND COMPONENTS, AND INDEXED MEDICARE CAPITATION PAYMENT (lAAPCC) 



Metropolitan 
Area Code* 

2650 



Metropolitan Area 



2870 
2680 
2700 
2710 
2720 
2750 
2760 
2800 
2840 
2880 
2900 
2920 
2960 
2975 
2980 
2985 
3000 
3040 
3060 
3080 
3120 
3150 
3160 
3180 
3200 
3240 
3283 
3290 
3320 
3350 
3360 
3400 
3440 
3480 
3500 
3520 
3560 
3580 
3600 
3605 
3610 
3620 
3640 
3660 
3680 
3710 



Florence, AL MSA 

Florence, SC MSA 

Fort Collins-Loveland, CO MSA 

Fort Lauderdale, FL PMSA 

Fort Myers-Cape Coral, FL MSA 

Fort Pierce-Port St. Lucie, FL MSA 

Fort Smith, AR-OK MSA 

Fort Walton Beach, FL MSA 

FortWayne, INMSA 

Fort Worth-Arlington, TX PMSA 

Fresno, CA MSA 

Gadsden, AL MSA 

Gainesville, FL MSA 

Galveston-Texas City, TX PMSA 

Gary, IN PMSA 

Glens Falls, NY MSA 

Goidsboro, NC MSA 

Grand Forks, ND-MN MSA 

Grand Rapids-Muskegon-Holland, Ml MSA 

Great Falls, MT MSA 

Greeley, CO PMSA 

Green Bay, Wl MSA 

Greensboro-Winston-Salem-High Poi 

Greenville, NC MSA 

Greenville-Spartanburg-Anderson, SC MSA 

Hagerstown, MD PMSA 

Hamilton-Middletown, OH PMSA 

Harrisburg-Lebanon-Carlisle, PA MSA 

Hartford, CTNECMA 

Hickory-Morganton, NC MSA 

Honolulu, HI MSA 

Houma, LA MSA 

Houston, TX PMSA 

Huntington-Ashland, WV-KY-OH MSA 

Huntsville, AL MSA 

Indianapolis, IN MSA 

Iowa City, lA MSA 

Jackson, Ml MSA 

Jackson, MS MSA 

Jackson, TN MSA 

Jacksonville, FL MSA 

Jacksonville, NC MSA 

Jamestown, NY MSA 

Janesville-Beloit, Wl MSA 

Jersey City, NJ PMSA 

Johnson City-Kingsport-Bristol, MSA 

Johnstown, PA MSA 

Joplin, MO MSA 



COMPONENTS OF GIPI 










1996 MFS 




PPS 


1 =Large 


Geographic 






Hospital 


Urban 


Adjustment 






Wage Index" 


Area 


Factor"* 
0.918 


GIPI 


lAAPCC"** 


0.769 





0.857 


0.932 


0.838 





0.899 


0.890 


0.867 


0.969 





0.949 


0.972 


0.817 


1.067 


1 - 


- 1.097 


1.059 


1.352 


0.950 





0.978 


0.968 


0.995 


0.975 





1.012 


0.990 


1.068 


0.793 





0.887 


0.864 


0.817 


0.905 





0.947 


0.937 


0.934 


0.863 





0.921 


0.909 


0.708 


0.956 


1 


0.971 


0.972 


0.942 


1.047 





0.970 


1.019 


0.800 


0.808 





0.914 


0.877 


0.960 


0.885 





0.966 


0.931 


0.887 


1.031 





0.998 


1.016 


1.183 


0.961 





0.947 


0.967 


1.117 


0.901 





0.967 


0.940 


0.805 


0.860 





0.888 


0.900 


0.791 


0.892 





0.901 


0.920 


0.660 


0.986 





1.020 


0.997 


0.787 


0.866 





0.902 


0.906 


0.871 


0.917 





0.934 


0.941 


0.879 


0.882 





0.957 


0.927 


0.649 


0.910 


1 


0.933 


0.939 


0.840 


0.870 





0.908 


0.910 


0.903 


0.874 





0.913 


0.913 


0.734 


0.905 





0.956 


0.939 


0.821 


0.866 





0.974 


0.922 


0.927 


0.973 





0.971 


0.979 


0.908 


1.209 


1 


1.090 


1.134 


1.018 


0.868 





0.909 


0.909 


0.810 


1.173 





1.093 


1.157 


0.877 


0.796 





0.917 


0.872 


1.097 


0.984 


1 


1.028 


1.000 


1.217 


0.877 





0.926 


0.917 


0.861 


0.823 





0.958 


0.896 


0.882 


0.986 


1 


0.949 


0.983 


0.986 


0.917 





0.939 


0.942 


0.720 


0.925 





1.020 


0.964 


0.975 


0.748 





0.940 


0.851 


0.794 


0.822 





0.905 


O.Ra3 


0.831 


0.887 





0.989 


0.937 


1.072 


0.700 





0.873 


0.810 


0.862 


0.743 





0.920 


0.844 


0.753 


0.853 





0.958 


0.912 


0.767 


1.095 





1.082 


1.069 


1.125 


0.869 





0.901 


0.908 


0.828 


0.869 





0.900 


0.907 


1.094 


0.779 





0.902 


0.859 


0.774 

3 

dcgVinal\Tab-g1 \nab 



TABLE G-1 

1 

ALTERNATIVE GEOGRAPHIC ADJUSTMENT FACTORS BY METROPOLITAN AREA: 

GEOGRAPHIC INPUT PRICE INDEX (GIPl) AND COMPONENTS. AND INDEXED MEDICARE CAPITATION PAYMENT (lAAPCC) 







COMPONENTS OF GlPI 












1996 MPS 








PPS 


1 =Large 


Geographic 






Metropolitan 




Hospital 


Urban 


Adjustment 






Area Code* 


Metropolitan Area 


Wage Index" 


Area 


Factor"* 
1.017 


GIPl 


lAAPCC**" 


3720 


Kalamazoo-Battle Creek. Ml MSA 


1.048 





1.029 


0.914 


3740 


Kankakee, IL PMSA 


0.925 





0.935 


0.945 


0.988 


3760 


Kansas City, MO-KS MSA 


0.944 


1 


0.981 


0.967 


1.048 


3800 


Kenosha, Wl PMSA 


0.863 





0.978 


0.922 


0.921 


3810 


Kllleen-Temple.TXMSA 


1.049 





0.925 


1.010 


0.759 


3840 


Knoxville, TN MSA 


0.858 





0.919 


0.906 


0.912 


3850 


Kokomo, IN MSA 


0.894 





0.928 


0.927 


0.977 


3870 


La Crosse, WI-MN MSA 


0.855 





0.937 


0.908 


0.654 


3880 


Lafayette, LA MSA 


0.780 





0.920 


0.864 


0.908 


3920 


Lafayette, IN MSA 


0.821 





0.901 


0.882 


0.715 


3960 


Lake Charles, LA MSA 


0.826 





0.939 


0.893 


1.056 


3980 


Lakeland-Winter Haven, FL MSA 


0.841 





0.956 


0.905 


0.784 


4000 


Lancaster, PA MSA 


0.945 





0.964 


0.963 


0.773 


4040 


Lansing-East Lansing, Ml MSA 


0.993 





1.035 


1.004 


1.041 


4080 


Laredo, TX MSA 


0.705 





0.905 


0.820 


0.829 


4100 


Las Cruces, NM MSA 


.0.890 





0,913 


0.922 


0.790 


4120 


Las Vegas, NV-AZ MSA 


1.112 





1.011 


1.063 


1.124 


4150 


Lawrence, KS MSA 


0.844 





0.929 


0.900 


0.755 


4200 


Lawton, OK MSA 


0.856 





0.903 


0.901 


0.795 


4243 


Lewiston-Aubum, ME NECMA 


0.971 





0.938 


0.971 


0.790 


4280 


Lexington, KY MSA 


0.852 





0.945 


0.908 


0.796 


4320 


Lima, OH MSA 


0.855 





0.928 


0.906 


0.776 


4360 


Lincoln, NE MSA 


0.909 





0.906 


0.930 


0.679 


4400 


Little Rock-North Little Rock, AR MSA 


0.834 





0.920 


0.893 


0.972 


4420 


Longview-Marshall, TX MSA 


0.867 





0.919 


0.911 


0.825 


4480 


Los Angeles-Long Beach, CA PMSA 


1.253 


1 


1.101 


1.160 


1.388 


4520 


Louisville, KY-IN MSA 


0.951 





0.941 


0.960 


1.017 


4600 


Lubtiock, TX MSA 


0.867 





0.922 


0.911 


1.172 


4640 


Lynchburg, VA MSA 


0.824 





0.919 


0.887 


0.676 


4680 


Macon, GA MSA 


0.890 





0.953 


0.931 


1.020 


4720 


Madison, Wl MSA 


0.990 





1.000 


0.995 


0.805 


4800 


Mansfield, OH MSA 


0.807 





0.933 


0.881 


0.783 


4840 


Mayaguez, PR MSA 


0.456 





0.770 


0.654 


0.331 


4880 


McAllen-Edinburg-Mission, TX MSA 


0.791 





0.902 


0.866 


0.815 


4890 


Medford-Ashland, OR MSA 


0.949 





0.958 


0.963 


0.681 


4900 


Melbourne-Titusville-Palm Bay, FL MSA 


0.871 





1.000 


0.931 


1.030 


4920 


Memphis, TN-AR-MS MSA 


0.841 


1 


0.935 


0.902 


0,991 


4940 


Merced, CA MSA 


0.990 





0.956 


0.985 


1.032 


5000 


Miami. FL PMSA 


1.003 


1 


1.113 


1.029 


1.529 


5015 


Middlesex-Somerset-Hunterdon. NJ PMSA 


1.053 


1 


1.111 


1.055 


1.069 


5080 


Milw/aukee-Waukesha. Wl PMSA 


0.928 


1 


0.996 


0.962 


0,947 


5120 


Minneapolis-St. Paul, MN-WI MSA 


1.076 


1 


0.996 


1.042 


0.877 


5160 


Mobile, AL MSA 


0.763 





0.923 


0.855 


1.000 


5170 


Modesto, CA MSA 


1.130 





0.981 


1.065 


0.972 


5190 


Monmouth-Ocean, NJ PMSA 


1.069 


1 


1.061 


1.053 


1.049 


5200 


Monroe, LA MSA 


0.772 





0.916 


0.859 


1.049 


5240 


Montgomery, AL MSA 


0.814 





0.938 


0.886 


0.914 


5280 


Muncie, IN MSA 


0.961 





0.890 


0.955 


0.857 

4 

dcg\final\Tab-g1\nab 



TABLE G-1 

ALTERNATIVE GEOGRAPHIC ADJUSTMENT FACTORS BY METROPOLITAN AREA: 

GEOGRAPHIC INPUT PRICE INDEX (GIPI) AND COMPONENTS, AND INDEXED MEDICARE CAPITATION PAYMENT (lAAPCC) 







COMPONENTS OF GIPI 












1996 MFS 








PPS 


1 =Large 


Geographic 






Metropolitan 




Hospital 


Urban 


Adjustment 






Area Code* 


Metropolitan Area 


Wage Index" 


Area 


Factor*" 
0.908 


GIPI 


lAAPCC*"* 


5330 


Myrtle Beacin, SC MSA 


0.785 





0.864 


0.833 


5345 


Naples, FL MSA 


0.946 





1.012 


0.974 


0.910 


5360 


Nastiville, TN MSA 


0.938 




0.947 


0.957 


1.070 


5380 


Nassau-Suffolk, NY PMSA 


1.352 




1.195 


1.234 


1.239 


5483 


New Haven-Bridgeport-Stamford NECMA 


1.211 




1.124 


1.143 


1.030 


5523 


New London-Nowich, CT NECMA 


1.158 





1.066 


1.099 


0.859 


5560 


New Orleans, LA MSA 


0.959 




0.975 


0.974 


1.343 


5600 


New York, NY PMSA 


1.394 




1.173 


1.252 


1.536 


5640 


Newark, NJ PMSA 


1.187 




1.104 


1.125 


1.131 


5660 


Newburgh, NY-PA PMSA 


1.006 





1.079 


1.021 


1.027 


5720 


Norfolk-Virginia Beach-Newport News MSA 


0.829 




0.949 


0.898 


0.938 


5775 


Oakland, CA PMSA 


1.467 




1.090 


1.272 


1.194 


5790 


Ocala, FL MSA 


0,872 





0.944 


0.919 


0.834 


5800 


Odessa-Midland. TX MSA 


0.820 





0.944 


0.891 


0.920 


5880 


Oklahoma City, OK MSA 


0.848 





0.926 


0.902 


0.884 


5910 


Olympia, WA PMSA 


1.103 





0.985 


1.052 


0.875 


5920 


Omaha, NE-IA MSA 


0.984 





0.925 


0.975 


0.917 


5945 


Orange County, CA PMSA 


1.237 


1 


1.090 


1.149 


1.300 


5960 


Orlando, FL MSA 


0.932 


1 


1.006 


0.967 


1.027 


5990 


Owensboro, KY MSA 


0.786 





0.903 


0.863 


0.824 


6015 


Panama City, FL MSA 


0.738 





0.938 


0.845 


0.961 


6020 


Parkersburg-Marietta, WV-OH MSA 


0.792 





0.920 


0.870 


0.884 


6080 


Pensacola, FL MSA 


0.813 





0.949 


0.888 


1.005 


6120 


Peoria-Pekin, IL MSA 


0.828 





0.937 


0.894 


0.802 


6160 


Philadelphia, PA-NJ PMSA 


1.123 


1 


1.058 


1.081 


1.313 


6200 


Phoenix-Mesa, A2 MSA 


1.005 


1 


1.000 


1.005 


1.095 


6240 


Pine Bluff, AR MSA 


0.870 





0.897 


0.907 


0.781 


6280 


Pittsburgh, PA MSA 


0.992 


1 


0.961 


0.989 


1.228 


6323 


Pittsneld, MA NECMA 


1.101 





1.005 


1.055 


1.023 


6360 


Ponce. PR MSA 


0.452 





0.789 


0.656 


0.420 


6403 


Portland, ME NECMA 


0.942 





0.997 


0.968 


0.832 


6440 


Portland-Vancouver, OR-WA PMSA 


1.112 


1 


0.976 


1.057 


0.893 


6483 


Providence-Warwick-Pawtucket, Rl NECMA 


1.085 


1 


1.065 


1.062 


0.988 


6520 


Provo-Orem, UT MSA 


0.987 





0.901 


0.971 


0.793 


6560 


Pueblo, CO MSA 


0.811 





0.919 


0.880 


0.828 


6580 


Punta Gorda, FL MSA 


0.906 





0.965 


0.941 


1.080 


6600 


Racine, Wl PMSA 


0.865 





0.973 


0.922 


0.804 


6640 


Raleigh-Durham-Chapel Hill, NC MSA 


0.963 





0.960 


0.971 


0.901 


6660 


Rapid City, SD MSA 


0.821 





0.889 


0.879 


0.696 


6680 


Reading, PA MSA 


0.926 





0.970 


0.954 


0.870 


6690 


Redding, CA MSA 


1.142 





0.954 


1.066 


0.978 


6720 


Reno, NV MSA 


1.107 





1.015 


1.061 


0.947 


6740 


Richland-Kennewick-Pasco, WA MSA 


0.958 





0.975 


0.972 


0.850 


6760 


Richmond-Petersburg, VA MSA 


0.938 





0.974 


0.961 


0.965 


6780 


Riverside-San Bernardino, CA PMSA 


1.173 


1 


1.015 


1.098 


1.156 


6800 


Roanoke. VA MSA 


0.807 





0.928 


0.880 


0.819 


6820 


Rochester, MN MSA 


1.037 





0.981 


1.016 


1.050 


6840 


Rochester, NY MSA 


0.967 


1 


0.994 


0.983 


0.931 

5 

dcg\final\Tab-g 1 \na b 



TABLE G-1 I 

ALTERNATIVE GEOGRAPHIC ADJUSTMENT FACTORS BY METROPOLITAN AREA: 

GEOGRAPHIC INPUT PRICE INDEX (GIPI) AND COMPONENTS, AND INDEXED MEDICARE CAPITATION PAYMENT (lAAPCC) 







COMPONENTS OF GIPI 












1996 MFS 








PPS 


1 =Large 


Geographic 






Metropolitan 




Hospital 


Urban 


Adjustment 






Area Code* 


Metropolitan Area 


Wage Index" 
0.862 


Area 


Factor*" 
0.938 


GIPI 


lAAPCC"** 


6880 


Rockford, ILMSA 





0.912 


0.754 


6895 


Rocky Mount, NC MSA 


0.839 





0.893 


0.890 


0.836 


6920 


Sacramento, CA PMSA 


1.224 


1 


1.022 


1.127 


1.057 


6960 


Saginaw-Bay City-Midland, Ml MSA 


0.939 





1.022 


0.972 


0.952 


6980 


St. Cloud, MN MSA 


0.963 





0.928 


0.964 


0.668 


7000 


St. Joseph, MO MSA 


0.870 





0.918 


0.912 


0.821 


7040 


St. Louis, MO-IL MSA 


0.908 


1 


0.982 


0.948 


1.013 


7080 


Salem, OR PMSA 


0.932 





0.938 


0.950 


0.723 


7120 


Salinas, CA MSA 


1.377 





1.026 


1.207 


0.966 


7160 


Salt Lake City-Ogden. UT MSA 


0.950 


1 


0.933 


0.960 


0.806 


7200 


San Angelo, TX MSA 


0.708 





0.898 


0.820 


0.758 


7240 


San Antonio. TX MSA 


0.826 


1 


0.948 


0.897 


0.974 


7320 


San Diego, CA MSA 


1.199 


1 


1.024 


1.114 


1.140 


7360 


San Francisco, CA PMSA 


1.407 


1 


1.140 


1.251 


1.076 


7400 


San Jose, CA PMSA 


1.441 


1 


1.132 


1.267 


1.034 


7440 


San Juan-Bayamon, PR PMSA 


0.436 


1 


0.803 


0.652 


0.420 


7460 


San Luis Obispo-Atascadero-Paso Rob 


1.254 





1.020 


1.140 


0.890 


7480 


Santa Barbara-Santa Maria-Lompoc, CA MSA 


1.142 





1.052 


1.087 


0.869 


7485 


Santa Cmz-Watsonville, CA PMSA 


1.368 





1.064 


1.211 


0.994 


7490 


Santa Fe, NM MSA 


1.091 





1.001 


1.049 


0.769 


7500 


Santa Rosa, CA PMSA 


1.303 





1.052 


1.174 


0.994 


7510 


Sarasota-Bradenton, PL MSA 


0.963 





0.991 


0.978 


0.935 


7520 


Savannah, GAMS A 


0.937 





0.955 


0.956 


1.037 


7560 


Scranton-Wilkes-Ban-e-Hazleton, PA MSA 


0.861 





0.933 


0.910 


1.011 


7600 


Seattle-Bellevue-Everett, WA PMSA 


1.093 


1 


1.017 


1.056 


0.927 


7610 


Sharon, PA MSA 


0.905 





0.915 


0.930 


1.003 


7620 


Sheboygan, Wl MSA 


0.804 





0.951 


0.884 


0.630 


7640 


Sherman-Denison, TX MSA 


0.891 





0.916 


0.922 


0.883 


7680 


Shreveport-Bossier City. LA MSA 


0.905 





0.933 


0.934 


0.913 


7720 


Sioux City, lA-NE MSA 


0.859 





0.903 


0.903 


0.796 


7760 


Sioux Falls, SD MSA 


0.859 





0.900 


0.902 


0.732 


7800 


South Bend, IN MSA 


0.959 





0.927 


0.962 


0.788 


7840 


Spokane, WA MSA 


1.040 





0.956 


1.012 


0.908 


7880 


Springfield, IL MSA 


0.868 





0.964 


0.921 


0.931 


7920 


Springrield, MO MSA 


0.784 





0.920 


0.866 


0.779 


8003 


Springfield, MA NECMA 


1.029 





1.017 


1.019 


0.963 


8050 


State College. PA MSA 


1.002 





0.952 


0.990 


0.877 


8080 


Steubenville-Weirton, OH-WV MSA 


0.832 





0.913 


0.890 


1.139 


8120 


Stockton-Lodi.CAMSA 


1.138 





1.003 


1.075 


0.987 


8140 


Sumter. SC MSA 


0.780 





0.881 


0.855 


0.726 


8160 


Syracuse. NY MSA 


0.960 





0.974 


0.973 


0.849 


8200 


Tacoma. WA PMSA 


1.034 





0.976 


1.013 


0.877 


8240 


Tallahassee. FL MSA 


0.823 





0.983 


0.901 


0.831 


8280 


Tampa-St. Petersburg-Clearwater, FL MSA 


0.937 


1 


0.989 


0.966 


1.038 


8320 


Terre Haute, IN MSA 


0.873 





0.890 


0.907 


0.803 


8360 


Texarkana, TX-Texarkana, AR MSA 


0.784 





0.911 


0.864 


0.989 


8400 


Toledo, OH MSA 


0.999 





0.976 


0.994 


1.126 


8440 


Topeka, KS MSA 


0.978 





0.965 


0.980 


0.817 

6 

dcg\final\Tab-g1\nab 



TABLE G-1 

ALTERNATIVE GEOGRAPHIC ADJUSTMENT FACTORS BY METROPOLITAN AREA: 

GEOGRAPHIC INPUT PRICE INDEX (GIPI) AND COMPONENTS, AND INDEXED MEDICARE CAPITATION PAYMENT (lAAPCC) 



COMPONENTS OF GIPI 



Metropolitan 
Area Code* 

&480 

8^0 

8560 

8600 

8640 

8680 

8720 

8735 

8750 

8760 

8780 

8800 

8840 

8920 

8940 

8960 

9000 

9040 

9080 

9140 

9160 

9200 

9260 

9270 

9280 

9320 

9340 

9360 

9901 

9902 

9904 

9905 

9906 

9908 

9909 

9910 

9912 

9913 

9915 

9916 

9917 

9918 

9919 

9920 

9921 

9922 

9923 

9924 



Metropolitan Area 



Trenton, NJ PMSA 
Tucson, AZ MSA 
Tulsa, OK MSA 
Tuscaloosa, AL MSA 
Tyler, TX MSA 
Utica-Rome, NY MSA 
Vallejo-Fairfield-Napa, CA PMSA 
Ventura, CA PMSA 
Victoria, TX MSA 

Vineland-Millvide-Bridgeton, NJ PMSA 
VisaRa-Tularfc-Porterville, CA MSA 
Waco, TX MSA 

Washington. DC-MD-VA-WV PMSA 
Waterloo-Cedar Falls, lA MSA 
Wausau, Wl MSA 

West Palm Beach-Boca Raton, FL MSA 
Wheeling. WV-OH MSA 
Wichita, KS MSA 
Wichita Falls, TX MSA 
Williamsport, PA MSA 
Wilmington-Newark, DE-MD PMSA 
Wilmington, NC MSA 
Yakima. WA MSA 
Yolo, CA PMSA 
York, PA MSA 

Youngstown-Warren, OH MSA 
Yuba City, CA MSA 
Yuma, AZ MSA 

AL NONMETROPOLITAN AREA 
AK NONMETROPOLITAN AREA 
AZ NONMETROPOUTAN AREA 
AR NONMETROPOLITAN AREA 
CA NONMETROPOLITAN AREA 
CO NONMETROPOLITAN AREA 
CT NONMETROPOLITAN AREA 
DE NONMETROPOLITAN AREA 
FL NONMETROPOLITAN AREA 
GA NONMETROPOLITAN AREA 
HI NONMETROPOLITAN AREA 
ID NONMETROPOLITAN AREA 
IL NONMETROPOLITAN AREA 
IN NONMETROPOLITAN AREA 
lA NONMETROPOLITAN AREA 
KS NONMETROPOLITAN AREA 
KY NONMETROPOLITAN AREA 
LA NONMETROPOLITAN AREA 
ME NONMETROPOLITAN AREA 
MD NONMETROPOLITAN AREA 







1996MFS 






PPS 


1 =Large 


Geographic 






Hospital 


Urban 


Adjustment 






Wage Index" 


Area 


Factor"* 
1.071 


GIPI 


lAAPCC"" 


1.011 





1.022 


1.230 


0.947 





0.977 


0.967 


0.993 


0.817 





0.926 


0.885 


0.936 


0.797 





0.934 


0.876 


0.955 


0.968 





0.931 


0.967 


0.850 


0.840 





0.945 


0.902 


0.772 


1.298 





1.033 


1.167 


1.095 


1.164 





1.077 


1.105 


1.107 


0.877 





0.926 


0.917 


1.010 


1.015 





1.005 


1.009 


1.086 


1.042 





0.956 


1.013 


0.839 


0.816 





0.921 


0.883 


0.612 


1.111 


1 


1.088 


1.082 


1.099 


0.866 





0.914 


0.909 


0.819 


0.992 





0.940 


0.982 


0.686 


1.010 





1.061 


1.019 


1.176 


0.751 





0.907 


0.845 


0.941 


0.978 





0.968 


0.981 


0.956 


0.775 





0.904 


0.858 


0.743 


0.852 





0.930 


0.905 


0.898 


1.083 





1.036 


1.052 


1.089 


0.891 





0.930 


0.926 


0.943 


0.940 





0.947 


0.956 


0.751 


1.157 





0.986 


1.081 


0.944 


0.911 





0.948 


0.941 


0.786 


0.932 





0.942 


0.951 


1.061 


1.031 





0.948 


1.005 


0.946 


0.844 





0.974 


0.911 


0.912 


0.695 





0.893 


0.812 


0.884 


1.257 





1.116 


1.213 


0.917 


0.822 





0.956 


0.895 


0.795 


0.683 





0.859 


0.798 


0.779 


1.003 





0.954 


0.991 


0.921 


0.794 





0.909 


0.869 


0.762 


1.175 





1.050 


1.105 


0.947 


0.853 





0.952 


0.910 


0.908 


0.844 





0.953 


0.906 


0.935 


0.750 





0.910 


0.846 


0.862 


0.963 





1.050 


1.035 


0.734 


0.825 





0.897 


0.883 


0.723 


0.736 





0.887 


0.833 


0.754 


0.787 





0.888 


0.860 


0.793 


0.732 





0.880 


0.829 


0.696 


0.723 





0.894 


0.827 


0.782 


0.749 





0.891 


0.840 


0.854 


0.732 





0.891 


0.831 


0.924 


0.850 





0.936 


0.905 


0.713 


0.860 





0.958 


0.915 


0.844 

7 

dcg\fina!\Tab-g1\nab 



TABLE G-1 

ALTERNATIVE GEOGRAPHIC ADJUSTMENT FACTORS BY METROPOLITAN AREA: 

GEOGRAPHIC INPUT PRICE INDEX (GIPI) AND COMPONENTS, AND INDEXED MEDICARE CAPITATION PAYMENT (lAAPCC) 



COMPONENTS OF GIPI 



Metropolitan 
Area Code* 

9925 

9926 

9927 

9928 

9929 

9930 

9931 

9932 

9933 

9935 

9936 

9937 

9938 

9939 

9940 

9941 

9942 

9944 

9945 

9946 

9947 

9948 

9949 

9950 

9951 

9953 

9954 

9955 

9956 

9972 

9966 

9978 



Metropolitan Area 



MA NONMETROPOLITAN AREA 
Ml NONMETROPOLITAN AREA 
MN NONMETROPOLITAN AREA 
MS NONMETROPOLITAN AREA 
MO NONMETROPOLITAN AREA 
MT NONMETROPOLITAN AREA 
NE NONMETROPOLITAN AREA 
NV NONMETROPOLITAN AREA 
NH NONMETROPOLITAN AREA 
NM NONMETROPOLITAN AREA 
NY NONMETROPOLITAN AREA 
NC NONMETROPOLITAN AREA 
ND NONMETROPOLITAN AREA 
OH NONMETROPOLITAN AREA 
OK NONMETROPOLITAN AREA 
OR NONMETROPOLITAN AREA 
PA NONMETROPOLITAN AREA 
Rl NONMETROPOLITAN AREA 
SC NONMETROPOLITAN AREA 
SD NONMETROPOUTAN AREA 
TN NONMETROPOLITAN AREA 
TX NONMETROPOLITAN AREA 
UT NONMETROPOLITAN AREA 
VT NONMETROPOLITAN AREA 
VA NONMETROPOLITAN AREA 
WA NONMETROPOLITAN AREA 
WV NONMETROPOLITAN AREA 
Wl NONMETROPOLITAN AREA 
WY NONMETROPOLITAN AREA 
PR NONMETROPOLITAN AREA 
GU NONMETROPOLITAN AREA 
VI NONMETROPOLITAN AREA 







1996 MPS 






PPS 


1 =Large 


Geographic 






Hospital 


Urban 


Adjustment 






Wage Index" 


Area 


Factor*" 
1.010 


GIPI 


lAAPCC**** 


1.045 





1.026 


0.893 


0.868 





0.972 


0.923 


0.859 


0.801 





0.894 


0.870 


0.655 


0.651 





0.879 


0.785 


0.834 


0.725 





0.890 


0.827 


0.747 


0.815 





0.900 


0.878 


0.755 


0.729 





0.849 


0.820 


0.611 


0.916 





0.981 


0.951 


0.799 


0.975 





0.981 


0.982 


0.796 


0.815 





0.893 


0.876 


0.724 


0.863 





0.950 


0.915 


0.822 


0.764 





0.889 


0.848 


0.791 


0.740 





0.869 


0.831 


0.753 


0.816 





0.924 


0.884 


0.818 


0.681 





0.870 


0.799 


0.749 


0.921 





0.917 


0.939 


0.739 


0.865 





0.916 


0.909 


0.930 


1.061 





1.071 


1.048 


0.903 


0.750 





0.891 


0.841 


0.719 


0.690 





0.849 


0.799 


0.674 


0.748 





0.879 


0.837 


0.905 


0.746 





0.893 


0.839 


0.829 


0.877 





0.905 


0.913 


0.788 


0.891 





0.936 


0.927 


0.717 


0.775 





0.898 


0.856 


0.819 


0.955 





0.929 


0.960 


0.827 


0.803 





0.901 


0.872 


0.884 


0.824 





0.925 


0.888 


0.670 


0.799 





0.918 


0.874 


0.778 


0.439 





0.755 


0.641 


0.379 


- 


- 


- 


- 


0.416 


' 


" 


~ 


" 


0.374 



* Metropolitan Statistical Area (MSA), Primary Metropolitan Statistical Area (PMSA), New England County 

Metropolitan Area (NECMA), or state nonmetropolitan area code. The latter code is SSni' where "xx" is the state FIPS code. 

•• Based on FY1991 hospital wage data. 

•** Medicare Fee Schedule Geographic Adjustment Factor (GAF) to be Implemented on January 1 , 1996. This version not rescaled for budget neutrality. 

"~ Based on 1 995 elderly Part A plus Part B AAPCC rates, weighted by 1 993 county Medicare enrollment 

SOURCE: For PPS hospital wages and large urtjan areas: Health Care Financing Administration. For GAF: Health Economics Research, Inc. 



8 

dcg\final\Tab-g1\nab 



APPENDIX H 

CONCURRENT DIAGNOSTIC GROUP (DXGROUP) 

AND HIERARCHICAL COEXISTING 

CONDITIONS STATISTICS 



TABLE H-1 

1992 MEDICARE PRCX3RAM EXPENDITURES AND 1992 FREQUENCY OF ENROLLEES FOR 
CONCURRENT PRINCIPAL INPATIENT DIAGNOSTIC GROUPS (UPPER CASE LABELS) 
AND HOSPITAL AND PHYSICIAN DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXG 



Label 



- ENTIRE 2.5% MODEL DEVELOPMENT SAMPLE 

-1 DIAG CODE NOT VALID 
-1.0 diag code not valid 

NO INPATIENT CUM MS IN DATA 
0.0 no claims In any data 

INFECTIOUS AND PARASITIC DISEASES 



Frequency* 

680,188 

10 

5,032 

35.521 
71.102 



Mean 
Expenditures" 

$3,783 

27,398 
9,711 



816 
49 



Standard 

Error 
of Mean 

$13 

6,522 
260 

3 
3 



Coefficient 

of Variation 

(X 100) 

273 

75 

190 

226 
1,780 



1 CENTRAL NERVOUS SYSTEM INFECTION (EG, MENINGITIS, ENCEPHALITIS) 
1.01 central nervous system infection (e.g.. meningitis, encephalitis) 

2 SEPTICEMIA/SHOCK (BLOOD POISONING) 
2.01 septicemia/shock (blood poisoning) 

3 HIV/AIDS (INCLUDING PNEUMOCYTOSIS) 
3 01 HIV/AIDS (including pneumocytosis) 

4 OTHER INFECTIOUS AND PARASITIC DISEASES 

4.01 bacterial enteritis (intestinal infections) 

4.02 viral enteritis (intestinal infections) 

4.03 other intestinal infections 

4.04 tuberculosis 

4.05 strep throat/scarlet fever 

4.06 other bacterial infections 

4.07 liaoterial infection in other diseases 

4.08 herpes zoster (shingles) 

4.09 herpes simplex 

4.10 viral hepatitis 

4. 1 1 other viral infections 

4.12 late syphilis, symptomatic 

4.13 dermatophytosis (fungal skin infections, eg., athlete's foot) 

4.14 thrush 

4.15 mycoses (fungal diseases), miscellaneous 

4.16 other infections 

LATE EFFECTS 



121 
1,872 

3,464 
11,212 

47 
500 

1,584 
1,531 
2,290 
2,488 
2.118 
1,189 
1.104 

11.359 

7,288 

2,097 

769 

13,770 
322 

54,540 
1,463 
3,119 
8.919 



27.797 
14.862 

28,387 
29,248 

39,154 
18,714 

21,503 
21,832 

8,350 
10,217 
10,476 

4,855 
13,025 
18,951 

5.515 

7,225 
12,961 

5.220 
11,721 

6,688 
16,548 
13.923 

9.833 



2,394 
554 

478 
345 

6,299 
1.542 

697 
789 
317 
385 
430 
292 
695 
203 
129 
321 
768 
100 
1,137 
56 
577 
472 
204 



95 
161 

99 

125 

110 
164 

129 
141 
182 
188 
189 
207 
178 
114 
199 
204 
164 
225 
174 
195 
133 
189 
196 



5 L6.TE EFFECTS 

5.01 infection late effects 

5.02 cerebrovascular disease late effects 

5.03 injury late effects 



289 


30,182 


1,391 


78 


684 


11,953 


674 


148 


11.550 


14,816 


181 


131 


1.769 


13,931 


432 


130 



MALIGNANT NEOPLASM 



6 MOUTH/PHARYNX/LARYNX/OTHER RESPIRATORY CANCER 

6.01 cancer of moutWlongue 

6.02 cancer of pharynx 

6.03 cancer of larynx 

6.04 other respiratory/intrathoracic cancer 

7 STOMACH/SMALL BOWELyLIVER/PANCREAS/ESOPHAGUS CANCER 

7.01 cancer of esophagus 

7.02 cancer of stomach 

7.03 cancer of small tiowel/peritoneum 

7.04 cancer of liver 

7.05 cancer of pancreas 

7.06 other cancer of digestive ofgans/peritoneum 

8 COLON CANCER 
8.01 colon cancer 

9 RECTAL CANCER 

9.01 rectal cancer 

10 LUNG CANCER 

10.01 lung cancer 



312 


29,466 


1,421 


85 


1,121 


13.201 


627 


159 


756 


16.799 


871 


143 


1,043 


12.889 


668 


167 


529 


15,517 


1,039 


154 


969 


33,487 


1.054 


98 


592 


22.572 


1.254 


135 


1,065 


21.119 


794 


123 


818 


22.008 


784 


102 


1,120 


22,024 


750 


114 


1,041 


21,665 


909 


135 


656 


16,469 


800 


124 


1,440 


24,496 


477 


74 


7,149 


13,001 


209 


136 


570 


24,585 


643 


62 


5,714 


13,318 


234 


133 


1,773 


29.930 


547 


77 


7,537 


18,023 


253 


122 



dcgWnaMabteh-1'ftt»J 



TABLE H-1 

1992 MEDICARE PROGRAM EXPENDITURES AND 1992 FREQUENCY OF ENROLLEES FOR 
CONCURRENT PRINCIPAL INPATIENT DIAGNOSTIC GROUPS (UPPER CASE LABELS) 
AND HOSPITAL AND PHYSICIAN DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXG 



Label 



MALIGNANT NEOPLASM 



(continued) 



11 
11.01 



BREAST CANCER 
breast cancer 



12 HODGKIN-S DISEASE/LYMWHOMA/MYELOMAA.EUKEMIA 

12.01 lymphoma/Karposi's sarcoma/Hodgkin's Disease 

12.02 multiple myeloma 

12.03 lymphoid leukemia 

12.04 myeloid leukemia 

12.05 other leukemia 

13 CANCER OF UTERUS/CERVDWFEMALE GENITAL ORGANS 

13.01 cancer of utems 

13.02 cancer of cervix/female genital organs 

14 CANCER OF PLACENTA/OVARY/UTERINE ADNEXIA 
14.01 cancer of ovaries/placenta/uterine adnexia 

1 5 CANCER OF PROSTATE/TESTIS/MALE GENITAL ORGANS 

15.01 prostate cancer 

15.02 cancer of testis/male genital organs 

16 CANCER OF BLADDER/KIDNEY/URINARY ORGANS 
1 6. 01 cancer of bladder/kidney/urinary organs 

17 NEOPLASM OF NERVOUS SYSTEM 

17.01 cancer of the eye 

17.02 cancer of the brain/nervous system/pituitary, pineal glands 

17.03 tienign neoplasm brain/nervous system/pituitary, pineal glands 

18 OTHER CANCER 

18.01 cancer of bone and articular cartilage 

1 8.02 cancer of connective and other soft tissue 

18.03 melanoma 

18.04 skin cancer, except melanoma, including lip 

1 8. 05 thyroid/endocrine cancer 

18.06 other/ill-defined site cancer 

19 SECONDARY CANCERS 

1 9. 01 secondary cancer of lymph node 

19.02 secondary cancer of respiratory and digestive systems 

1 9.03 secondary cancer of other site 

19.04 disseminated cancer 







Standard 


Coefficient 




Mean 


Error 


of Variation 


Frequency* 


Expenditures" 


of Mean 


(X 100) 


1,394 


11,180 


283 


95 


13,646 


5.881 


94 


187 


827 


35.017 


1,043 


86 


3,519 " 


12.796 


340 


158 


1,202 


13.907 


544 


136 


1,682 


11,195 


498 


182 


623 


21,110 


1,270 


150 


1,206 


16.711 


747 


155 


500 


16.856 


677 


90 


1,942 


8,611 


323 


165 


1.308 


9,778 


451 


157 


196 


29,452 


1,453 


59 


1,321 


15,364 


559 


132 


2,036 


14,494 


286 


89 


17,347 


7,844 


100 


163 


406 


11.429 


797 


141 


1,012 


20,226 


583 


92 


6,343 


9,949 


210 


168 


336 


31,969 


1.175 


67 


335 


6,417 


645 


184 


2,439 


16,789 


457 


135 


1,679 


11,408 


405 


145 


440 


21,296 


982 


97 


1,459 


16,828 


659 


150 


1,144 


13369 


579 


146 


1,610 


7,113 


308 


173 


25,168 


4,740 


61 


206 


631 


10,923 


734 


169 


9,224 


14,788 


213 


138 


2,454 


31,965 


534 


83 


2.774 


22,043 


447 


107 


5,974 


24,121 


297 


95 


7,728 


20,137 


258 


112 


1.683 


18.876 


601 


131 



BENIGN NEOPLASM, CARCINOMA IN SITU 



20 BENIGN NEOPLASMS 

20.01 tienign neoplasm of digestive system 

20.02 benign neoplasm of respiratory system 

20.03 benign neoplasm of skin 

20.04 benign neoplasm of breast 

20.05 benign neoplasm of urinary 

20.06 benign neoplasm of eye 

20.07 other benign neoplasms 

21 CARCINOMA IN SITU/NEOPLASM OF UNCERTAIN BEHAVIOR 

21 .01 carcinoma in situ of digestive organs 

21 .02 carcinoma in situ of respiratory system 

21.03 carcinoma in situ of other sites, excluding skin 

21.04 neoplasm of uncertain behavior, specified sites 

21 .05 neoplasm of uncertain behavior nec/nos 

21.06 unspecified neoplasm 



871 


13,827 


604 


129 


19.186 


7,494 


96 


178 


1.446 


16,119 


651 


154 


18,021 


3,709 


60 


215 


71.490 


3,150 


27 


225 


995 


11,054 


524 


150 


1.131 


3,964 


241 


205 


13.207 


7.077 


111 


181 


577 


21.625 


1,072 


119 


1.746 


16,989 


516 


127 


1.049 


19,571 


658 


109 


4,932 


10119 


217 


150 


6,851 


12,209 


217 


147 


12,545 


6,278 


116 


207 


23,360 


10,702 


111 


159 



dcgWnaMaWeh-IMmd 



TABLE H-1 

1992 MEDICARE PROGRAM EXPENDITURES AND 1992 FREQUENCY OF ENROLLEES FOR 
CONCURRENT PRINCIPAL INPATIENT DIAGNOSTIC GROUPS (UPPER CASE LABELS) 
AND HOSPITAL AND PHYSICIAN DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXG 



Label 



ENDOCRINE. NUTRITIONAL, AND METABOLIC DISEASES 

22 DIABETES WITHOUT COMPLICATIONS 
22.01 diabetes without complications 

23 DIABETES WITH ACUTE COMPLICATIONS 
23.01 diabietes with acute complications 

24 DIABETES WITH CHRONIC COMPLICATIONS 

24.01 diatietes witti renal maniliestation 

24.02 diatietes witti other specified complications 

24.03 diabietes with unspecified complications 

25 HYPOGLYCEMIA 

25.01 hypoglycemic coma 

25.02 other hypoglycemia 

26 DISORDERS OF FLUlD/ELECTROLYTeACID BASE BALANCE 
26.01 disorders of fluid/eleotro!yte/acid-base balance 

27 OTHER ENDOCRINE/NUTRITIONAL/METABOLIC DISEASES 

27.01 goiter 

27.02 thyrotoxicosis, including Graves' disease 

27.03 thyroid disorders 

27.04 adrenal gland disorders, e.g.. Cushing's syndrome 

27.05 ovarian dysfunction 

27.06 testicular dysfunction 

27.07 other endocrine disorders 

27.08 pituitary/parathyroid/thymus/polyglandular disorders 

27.09 protein-calorie malnutrition 

27.10 vitamin/other nutritional deficiencies (e.g.. PKU. rickets, scurvey) 

27. 1 1 disorders of lipoid metabolism (high cholesterol) 

27.12 disorders of plasma protein metatxjiism 

27.13 disorders of mineral metabolism 

27.14 cystic fibrosis, porphyria, metabolism disorders, nec/nos 

27.15 other hyperalimentation 

27.16 obesity/localized adiposity 







Standard 


Coefficient 




Mean 


Error 


of Variation 


Frequency* 


Expenditures'* 


of Mean 


(X 100) 


454 


28,619 


1,594 


119 


91.607 


6.857 


47 


207 


359 


17,785 


977 


104 


3.258 


13.214 


349 


151 


2.239 


21.824 


492 


107 


1.779 


18.105 


577 


134 


11.385 


12.897 


186 


154 


16.976 


12.557 


148 


154 


534 


23,086 


1,194 


120 


706 


16,551 


825 


132 


4.323 


12.276 


291 


156 


4.536 


21.135 


303 


97 


54,428 


16.428 


93 


132 


853 


19.911 


650 


95 


4.114 


5.699 


185 


209 


5.890 


5.636 


144 


197 


39.609 


5.514 


58 


209 


1.640 


16.269 


648 


161 


1.752 


2.937 


165 


236 


485 


5.898 


542 


202 


2.984 


5,361 


203 


206 


2.647 


11.276 


373 


170 


7.511 


28.421 


389 


119 


5.622 


8,391 


210 


188 


95,053 


3,610 


28 


235 


1,797 


15.238 


514 


143 


4.110 


12.681 


341 


173 


1.852 


7.935 


350 


190 


448 


8.155 


778 


202 


8.022 


7.512 


150 


178 



GASTROINTESTINAL DISORDERS 



28 PANCREATITIS/ OTHER PANCREATIC DISORDERS 

28.01 acute pancreatitis 

28.02 chronic pancreatitis/other pancreatic diseases/intestinal malabsorption 

29 END STAGE LIVER DISORDERS 

29.01 end stage liver disorders 

29.02 esophageal varices 

30 OTHER LIVER DISORDERS 

30.01 cinhosis 

30.02 other liver disorders (e.g., toxic hepatitis) 

31 DISEASES OF ESOPHAGUS 
31.01 disease of esophagus 

32 ULCERS 

32.01 ulcer without perforation 

32.02 ulcer with perforation 

33 GASTRITIS/OTHER GASTRIC DISORDERS 

33.01 pyloric/duodenal obstmotion 

33.02 gastritis/other gastric disorder (stomach disorders) 

34 APPENDICITIS 
34.01 appendicitis 

35 ABDOMINAL HERNIA/ COMPLICATED 
35,01 abdominal hernia, complicated 



918 


18,716 


658 


107 


2,779 


16,279 


439 


142 


2,942 


15,369 


439 


155 


274 


32,368 


2.009 


103 


1,235 


24,697 


964 


137 


559 


20,078 


1,251 


147 


490 


26.667 


1,480 


123 


2,668 


14.476 


441 


157 


7,737 


11.956 


245 


180 


1,190 


15.912 


531 


115 


28,669 


8.021 


88 


185 


2,456 


17.340 


412 


118 


21,469 


9.660 


120 


182 


1,009 


17,668 


824 


148 


2,454 


18,149 


436 


119 


822 


18,863 


804 


122 


89.484 


8.926 


55 


184 


263 


13.832 


841 


99 


862 


15,764 


756 


141 


413 


16,884 


758 


91 


1.690 


12.312 


428 


143 



dcgVinaI\Tabletv1Mmd 



TABLE H-1 

1992 MEDICARE PROGRAM EXPENDITURES AND 1992 FREQUENCY OF ENROLLEES FOR 
CONCURRENT PRINCIPAL INPATIENT DIAGNOSTIC GROUPS (UPPER CASE LABELS) 
AND HOSPITAL AND PHYSICIAN DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXG 



Label 



GASTROINTESTINAL DISORDERS 



(continued) 



36 ABDOMINAL HERNIA/ UNCOMPUCATED 
36.01 abdominal hernia/uncomplicated 

37 INFLAM MATOR Y BOWEL DISEASE 

37.01 regional enteritis (Crohn's disease) 

37.02 ulcerative colitis 

38 PERITONITIS/INTESTINAL OBSTRUCTION 

38.01 intestinal otistmction 

38.02 peritonitis 

38.03 other peritoneal disorders 

39 DIVERTICULA OF INTESTINE 
39.01 divercula of intestine 

40 ANAL/RECTAL/GASTROINTESTINAL DISORDERS 

40.01 hemorrhoids 

40.02 anal/rectal disorders 

40.03 intestinal abcess/ulceration/perforation 

40.04 other intestinal disorders 

41 GALLBLADDER DISORDERS 

41.01 cholelithiasis (gallstones) 

41.02 biliary tract disease 

41.03 other gallbladder disorders 

42 GASTROINTESTINAL HEMORRHAGE 

42.01 gastrointestinal hemorrhage 

DISEASES OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE 

43 GOUT/ARTHROPATHY/DERANGEMENTS 
•43.01 gout/crystal arthropathy 

43.02 other arthropathy/joint disorders, derangements 

44 CONNECTIVE TISSUE DISEASES 

44 01 systemic lupus erythematosus, scleroderma, arteritis, and other connective tissue disease 

44.02 rheumatoid arthritis and other inflammatory polyarthropathy 

44.03 inflammatory spondylopathies 

44.04 polymyalgia rheumatica 

45 ARTHROPATHY/BONE INFECTION 

45.01 arthropathy with infection 

45.02 osteomyelitis 

46 OSTEOARTHRITIS 
4601 osteoarthrosis 

47 BACK PAIN 

47.01 back disorders (e.g.. slipped disk, lumbago, sciatica, Ijackache) 

48 DISORDERS OF SOFT TISSUES 

48.01 disorders of soft tissue (e.g., tendonitis, bursitis) 

49 OTHER BONE DISORDERS 

49.01 osteoporosis 

49.02 other bone disorders (e.g.. curvature of spine. Pagefs disease) 

49.03 flat foot, acquired deformities of toe 

49.04 other acquired limb deformities 







Standard 


Coefficient 




Mean 


Error 


of Variation 


Frequency* 


Expenditures"* 


of Mean 


(X 100) 


1,473 


11,053 


394 


137 


30,310 


7,547 


74 


172 


216 


20,352 


1,987 


143 


1,451 


10,089 


498 


188 


1,570 


9,127 


426 


185 


2.846 


20,748 


423 


109 


13.724 


19,016 


220 


135 


1.252 


34,754 


1,235 


126 


1.643 


19,315 


561 


118 


2.395 


15,307 


354 


113 


34,958 


6,895 


68 


185 


2,059 


17,258 


490 


129 


17,830 


5,060 


80 


211 


21.175 


7,141 


97 


193 


3.598 


17,101 


445 


156 


28.027 


9,149 


98 


179 


3,876 


15,085 


257 


106 


8,814 


11,933 


193 


152 


1,984 


20,264 


619 


136 


11,025 


12,949 


183 


149 


1,779 


19,583 


491 


106 


25,990 


12,556 


134 


172 


642 


19,548 


714 


93 


12,755 


6,047 


103 


193 


109,190 


6,573 


38 


190 


578 


21,162 


823 


94 


5,277 


8,048 


226 


204 


14,329 


6,584 


111 


202 


1,999 


6.748 


293 


194 


3,914 


6.396 


210 


206 


472 


30,087 


1,382 


100 


1,240 


14.454 


619 


151 


3,618 


17.102 


414 


146 


4,006 


18.708 


213 


72 


115,431 


5.440 


31 


196 


2,737 


15.302 


259 


89 


96,367 


6.049 


38 


195 


650 


17,405 


927 


136 


103,996 


6.279 


39 


203 


1,754 


21.216 


477 


94 


19,302 


8,828 


108 


171 


20,869 


8,917 


103 


166 


14,663 


5,202 


85 


193 


3,885 


11,853 


306 


161 



dcgVinaKTableh-lttmd 



TABLE H-1 

1992 MEDICARE PRCX3RAM EXPENDITURES AND 1992 FREQUENCY OF ENROLLEES FOR 
CONCURRENT PRINCIPAL INPATIENT DIAGNOSTIC GROUPS (UPPER CASE LABELS) 
AND HOSPITAL AND PHYSICIAN DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXG 



Label 



DISEASES OF BLOOD AND BLOOD4=ORMING ORGANS 

50 ANEMIA 

50.01 iron deficiency and other anemias 

51 OTHER BLOOD DISEASES 

51.01 sickle cell and other hereditary hemolytic anemias 

51.02 acquired hemolytic anemia 

51.03 aplastic anemia 

51.04 hemophilia and other coagulation defects 

51.05 purpura/thromtjocytopathy/hemorrhagic conditions 

51.06 white blood cell disorders 

51.07 immune disorders 

51.08 other blood disease 

MENTAL DISORDERS 







Standard 


Coefficient 




Mean 


Error 


of Variation 


Frequency* 


Expenditures** 


of Mean 


(X 100) 


1.020 


19.874 


667 


107 


66.030 


11.599 


71 


157 


875 


29.986 


1.056 


104 


982 


12.309 


805 


205 


629 


16,474 


841 


128 


2,308 


22.198 


580 


126 


6.644 


14.134 


293 


169 


4.582 


16621 


407 


166 


5.487 


17.515 


346 


146 


732 


15.456 


1.073 


188 


6.529 


10,380 


214 


167 



52 DEMENTIA 

52.01 senile/presenile psychoses 

52.02 other organic psychotic conditions 

52.03 cerebral degeneration/Alzheimer's disease/Reye's syndrome 

52.04 senility without psychosis 

53 SUBSTANCE-RELATED PSYCHOSES 

53.01 alcoholic psychoses 

53.02 drug psychoses 

54 DELIRIUM/HALLUCINATIONS 

54.01 delirium/delusions/hallucinations 

54.02 hallucinations, symptomatic 

55 SCHIZOPHRENIC DISORDERS 
55.01 schizophrenic disorders 

56 MANIC AND DEPRESSIVE DISORDERS 

56.01 manic and depressive disorders, including major depressive disorder 

57 PARANOIA AND OTHER PSYCHOSES 

57.01 paranoid states 

57.02 other nonorganic psychoses 

58 NEUROTIC DISORDERS 

53.01 neurotic disorders (e.g. anxiety, panic attack, phobias) 

59 SUBSTANCE ABUSE AND DEPENDENCE 

59.01 alcohol dependence 

59.02 dnjg dependence 

59.03 non-dependent abuse of drugs 

60 OTHER MENTAL DISORDERS 

60.01 personality disorders 

60.02 sexual deviations and disorders 

60.03 psychophysiologic disorders 

60.04 acute reaction to stress 

60.05 adjustment reaction 

60.06 nonpsychotic organic brain syndrome 

60.07 depression, not elsewhere classified 

60.08 behavior disorder 

60.09 developmental behavioral disorders 

60.10 mental retardation 

60. 1 1 other mental disorders 



1.595 


18,709 


432 


92 


19,373 


10,363 


111 


149 


3,057 


13,478 


346 


142 


15,417 


11,482 


144 


156 


1,381 


8,125 


357 


163 


347 


16,654 


814 


91 


1,131 


13,981 


518 


125 


1,077 


17,645 


623 


116 


485 


19,854 


918 


102 


4,964 


18,287 


326 


126 


772 


12,355 


534 


120 


1,668 


15,624 


342 


89 


8,476 


7,173 


137 


176 


2,542 


19,341 


332 


37 


13,282 


10,798 


146 


155 


695 


16,735 


586 


92 


868 


11.521 


537 


137 


15,284 


12.239 


139 


140 


391 


18.667 


938 


99 


28.674 


7.401 


79 


181 


831 


13.511 


446 


95 


3.410 


12.760 


311 


142 


977 


15,518 


588 


118 


5.830 


9,921 


190 


146 


805 


17,490 


717 


116 


2.014 


12,555 


373 


133 


1,396 


4,456 


239 


201 


925 


8,824 


440 


152 


1,686 


6,667 


356 


219 


4,152 


12,767 


342 


172 


9,019 


11,310 


179 


150 


14,429 


9,705 


136 


168 


727 


8,544 


553 


175 


874 


9,791 


586 


177 


3,739 


4,386 


174 


242 


2,232 


9,749 


333 


161 



dcgVinalVTableh-IMmd 



TABLE H-1 

1992 MEDICARE PROGRAM EXPENDITURES AND 1992 FREQUENCY OF ENROLLEES FOR 
CONCURRENT PRINCIPAL INPATIENT DIAGNOSTIC GROUPS (UPPER CASE LABELS) 
AND HOSPITAL AND PHYSICIAN DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXG 



Label 



NEUROLOGICAL DISORDERS 



Frequency* 



Mean 
Expenditures" 



Standard 

Error 
of Mean 



Coefficient 

of Variation 

(X 100) 



61 HEADACHES 

61.01 headaches, including migraine 

62 DEGENERATIVE NEUROLOGIC DISORDERS 

62.01 ParWnson's disease 

62.02 Huntington's Disease, essential tremor, other abnomial movement disorders 

62.03 anterior horn cell disease, including Lou Gehrig's disease (ALS) 

62.04 other spinal cord disease 

62.05 autonomic nerve disorder 

62.06 other hereditary and degenerative central nervous system diseases (e.g., Tay-Sachs) 



151 
26.664 

522 
9.313 
3.777 

497 
1.204 
1.463 

703 



12.287 
6,997 

20.611 
8,026 
8.127 
14.410 
15,824 
12,743 
11,017 



1,146 
82 

840 
148 
243 
1,186 
609 
508 
673 



115 

191 

93 
178 
184 
183 
134 
152 
162 



63 OTHER NEUROLOGIC DISORDERS 

63.01 multiple sclerosis, other central nervous system dymelination 

63.02 infantile cerebral palsy 

63.03 quadriplegia 

63.04 paraplegia 

63.05 Cauda equina syndrome 

63.06 other paralytic disorders 

63.07 nervous/musculoskeletal system symptoms 

63.08 other central nervous system disorders 

64 EPILEPSY AND OTHER SEIZURE DISORDERS 
64.01 epilepsy and other seizure disorders/convulsions 

65 MONONEUROPATHY 
65.01 trigeminal nerve disorder 

65 02 facial nerve disorders, including Bell's Palsy 

65.03 root/plexus disorders 

65.04 root/plexus lesions 

65.05 other cranial nerve disorders 

65.06 neuropathy of upper limb (e.g., carpal tunnel syndrome) 

65.07 neuropathy of leg 

66 POLYNEUROPATHY 

66.01 peripheral neuropathy 

66.02 inflammatoryAoxic neuropathy, including Gullain-Barre Syndrome 

66.03 myoneural disorders/myaslhenia gravis 

66.04 muscular dystrophies 
6605 other neuropathy 

67 CEREBRAL CYSTS, COMPRESSION, EDEMA. ANOXIC DAMAGE. 
OTHER BRAIN CONDITIONS 

67.01 cerebral cysts, compression, edema, anoxic damage, other brain conditions 



460 
1,692 

1.002 
705 
954 

3.607 

1.375 
10.723 

1,365 

1,368 
16.432 

210 

1,415 

1,639 

634 

582 

336 

6,628 

6,783 

193 
5,776 
3,179 
646 
859 
824 

182 

6,177 



24,498 
9,036 
6,110 
20,250 
19,354 
13,617 
17,362 
12,073 
18.124 

19,610 
10.702 

17.000 
5.812 
6.856 
7.583 
7,870 

10,438 
6,060 
7,383 

27.266 
9,277 
13567 
11,149 
14,208 
9,190 

26,460 

20,559 



1,019 
400 
422 

1,128 
858 
323 
622 
171 
695 

560 
149 

1,035 
281 
289 
628 
618 
953 
143 
163 

2,199 
207 
361 
724 
916 
612 

1,929 

376 



91 
182 
219 
148 
137 
142 
133 
147 
142 

106 
179 



182 
171 
208 
189 
167 
192 
182 

112 
169 
150 
165 
189 
191 



CIRCULATORY DISORDERS 



68 VALVULAR AND RHEUMATIC HEART DISEASE 

68.01 rheumatic fever/heart disease 

68.02 mitral or aortic valve/endocardia disease 

68.03 mitral/aortic valve disorders 

69 HYPERTENSION, UNCOMPUCATED 

69.01 essential hypertension 

69.02 hypertensive heart disease 

70 HYPERTENSION, COMPLICATED 

70.01 malignant hypertension 

70.02 malignant hypertensive heart disease 

70.03 hypertensive heart and renal disease 

70.04 secondary hypertension 

70.05 hypertension encephalopathy 

71 MYOCARDIAL INFARCTION (SUBSEQUENT EPISODE OF CARE) 

71.01 myocardial infarction (heart attack), subsequent episode of care 

71.02 old myocardial infarction (heart attack) 

71.03 coronary atherosclerosis, aneurysm of heart, other chronic ischemic heart disease 



791 


39.750 


1,415 


100 


4,000 


14.157 


363 


162 


32.667 


11.650 


103 


160 


6.860 


14.827 


245 


137 


1,449 


18.554 


542 


111 


241.606 


5,121 


23 


219 


27.676 


7,870 


86 


181 


872 


19,471 


796 


121 


18,041 


6.386 


98 


206 


3,000 


7.965 


291 


200 


4,201 


17.100 


413 


157 


714 


10,013 


583 


156 


1,179 


12,569 


560 


153 


3.988 


27,839 


374 


85 


13,585 


17,273 


194 


131 


11,091 


12,879 


166 


136 


124.428 


8.403 


43 


182 






6 

<jcg\finaMableh-1Mmd 



TABLE H-1 

1992 MEDICARE PROGRAM EXPENDITURES AND 1992 FREQUENCY OF ENROLLEES FOR 
CONCURRENT PRINCIPAL INPATIENT DIAGNOSTIC GROUPS (UPPER CASE LABELS) 
AND HOSPITAL AND PHYSICIAN DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXG 



Label 



CIRCULATORY DISORDERS 



(continued) 



72 ACUTE MYOCARDIAL INFARCTION (INITIAL EPISODE OF CARE) 
72.01 acute myocardial infarction (heart attack), initial episode of care 

73 OTHER ACUTE ISCHEMIA 
73.01 other acute ischemia 



74 
74.01 

75 
75.01 
75.02 

76 

76.01 
76.02 

77 
77.01 

78 

78.01 

79 
79.01 

80 
80.01 

81 
81.01 
81.02 
81.03 
81.04 
81.05 

82 
82.01 

83 
83.01 

84 
64.01 
84.02 

84.03 

65 
85.01 

86 
86.01 
86.02 

87 
87.01 
87.02 

88 
88.01 



ANGINA PECTORIS 
angina pectoris 

PULMONARY HEART DISEASE 
pulmonary embolism (blood clot) 
other pulmonary heart disease 

RHYTHM AND CONDUCTION DISORDERS 
conduction disorders/cardiac dysrhythmias 
premature heart beats 

ATRIAL ARRYTHMIA 
atrial arrhythmia 

VENTRICULAR TACHYCARDIA 
ventric tachycardia 

HEART ARREST/ SHOCK 
heart an^est/shock 

HEART FAILURE 
heart failure 

OTHER CARDIAC DISEASE 
pericarditis, post-MI 
acute endo/myocarditis 
cardiomyopathy/myocarditis 
cardiomegaly (enlarged heart) 
other heart disease 

CEREBRAL HEMORRHAGE 
cerebral hemorrhage 

PRECEREBRAL ARTERIAL OCCLUSION 
precerebral arterial occlusion 

CEREBROVASCULAR DISEASE (STROKE) 
cerebrovascular accident (stroke) 
hemiplegia (paralysis of one side of body) 
aphasia (loss of language skills/comprehension) 

TRANSIENT CEREBRAL ISCHEMIA 
transient cerebral ischemia 

ATHEROSCLEROSIS 

atherosclerosis of aorta, renal artery, and arteries of the extremities 

atherosclerosis/general, arteriosclerotic cardiovascular disease/arteriosclenjsis 

ANEURYSM 
aortic aneurysm 
other aneurysm 

ARTERIAL EMBOLISM AND THROMBOSIS 

arterial embolism and thramtwsis (blood clots) 



Frequency* 


Mean 
Expenditures" 


Standard 

Error 
of Mean 


Coefficient 

of Variation 

(X 100) 


6,450 
9,266 


22,516 
22,149 


278 

252 


99 
109 


7,275 

21,664 


19,338 
15,628 


235 
139 


104 
129 


2,128 
44,191 


15,395 
9,806 


376 
74 


113 
159 


791 
3,438 
6,277 


22,880 
20,696 
15,713 


718 
439 
292 


88 

124 
147 


2,998 
60,255 
13,292 


16,467 
9,644 
9,804 


283 
67 

136 


94 
171 
160 


3,358 
43,505 


14,823 
11,915 


282 
93 


110 
163 


517 
5.332 


27,365 
19,583 


1,212 
355 


101 
132 


291 
8,336 


34,724 
23,121 


2,001 
360 


98 
142 


11,168 
75,085 


21,290 
12,569 


208 
74 


103 
161 


693 
2,586 

712 
11,768 
23,604 
12,852 


27,236 
20,433 
22,656 
14,703 
14,847 
12,160 


963 
530 
1,145 
195 
138 
173 


93 
132 

135 
144 
143 
161 


1,093 
4,189 


26,860 
18,861 


869 
372 


107 
128 


1,489 
17,454 


17,261 
11,076 


388 
129 


87 
154 


7,526 

41,769 

7,520 

2,358 


22,023 
12,336 
19,579 
20,077 


249 

95 

250 

433 


98 
157 
111 
105 


2,548 
19,573 


12,316 
9,937 


266 
104 


109 
147 


892 
20,211 
41,221 


30,285 

11,466 

9,311 


808 

131 

78 


80 
162 
171 


1,030 
7,025 
1,868 


32,586 
13,449 
18,480 


1,073 
263 

619 


106 
164 
145 


982 
6,377 


29,422 
19,200 


803 
322 


85 

134 



dcgMinaMablelv1\liTKl 



TABLE H-1 

1992 MEDICARE PRCX3RAM EXPENDITURES AND 1992 FREQUENCY OF ENROLLEES FOR 
CONCURRENT PRINCIPAL INPATIENT DIAGNOSTIC GROUPS (UPPER CASE LABELS) 
AND HOSPITAL AND PHYSICIAN DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXG 



Label 



CIRCULATORY DISORDERS 



(continued) 



89 PERIPHERAL VASCULAR DISEASE 
89.01 specified peripheral vascular disease 
89 02 Raynaud's syndrome 

89.03 peripheral vascular disease 

89.04 other arterial disease 

89.05 disease of capillanes 

89.06 vascular insufficiency of intestines 

89.07 gangrene 

90 THROMBOPHLEBITIS 

90.01 phlebitis and thromtxiphlebitis 

90.02 noninfectious lymphatic disorders 

90.03 hemorrhage nos 

90.04 compression of vein 

91 HYPOTENSION (LOW BLOOD PRESSURE) 
91 .01 hypotension (low blood pressure) 

92 OTHER CIRCULATORY DISEASE 

92.01 superficial phlebitis-leg 

92.02 varicose veins 

92.03 other circulatory disease/postphlebitic syndrome 

92.04 ether specified circulatory disorders 







Standard 


Coefficient 




Mean 


Error 


of Variation 


Frequency* 


Expenditures" 


of Mean 


(X 100) 


1,179 


29,863 


812 


93 


3,082 


13,762 


406 


164 


948 


7,505 


526 


216 


30,616 


10,022 


97 


169 


6,846 


13,983 


266 


157 


918 


5,818 


429 


223 


1,550 


23,079 


882 


150 


3,370 


28,232 


545 


112 


1,663 


19,384 


470 


99 


13,716 


13,742 


179 


153 


1,511 


10,205 


412 


157 


1,126 


18,424 


915 


167 


933 


14.444 


713 


151 


599 


16,719 


783 


115 


8,113 


16,467 


267 


146 


479 


18,897 


910 


105 


1,949 


10,011 


363 


160 


9,265 


7,303 


138 


182 


5,777 


14,065 


294 


159 


8,196 


10,163 


196 


174 



DISORDERS OF THE EYE AND ADNEXA 



93 DISORDERS OF THE EYE AND ADNEXA 

93.01 diabetic retinopathy 

93.02 proliferative diabetic retinopathy 

93.03 endophthalmitis (eye inflammation) 

93.04 retinal disorders 
93-05 glaucoma 

93-06 cataract/lens replacement 

93.07 disorders of refraction and accommodation (e.g., far-, near-sightedness, astigmatism) 

93.08 vitreous hemorrhage 

93.09 other eye disorders 



945 


11,118 


492 


136 


9,906 


7,631 


133 


174 


1,909 


9.150 


336 


161 


520 


8,970 


673 


171 


54,643 


4,576 


41 


208 


56,024 


4,030 


38 


223 


177,409 


4,026 


21 


217 


22,684 


3,437 


53 


230 


1,414 


7,085 


293 


156 


118,492 


4,491 


28 


218 



DISORDERS OF THE EAR AND MASTOID PROCESS 



94 EAR DISORDERS 

94.01 impacted earvrax 

94.02 otitis media (middle ear infection) 

94.03 vertiginous syndromes (eg., wertigo, Meniere's disease) 

94.04 hearing loss 

94.05 other ear disorders 



494 


8,630 


463 


119 


27,319 


4,053 


55 


224 


16,385 


4,286 


75 


224 


11,455 


4,569 


85 


198 


17,444 


5,090 


81 


211 


20,486 


4,508 


69 


220 



DISEASES OF THE RESPIRATORY SYSTEM 



95 
95.01 
95.02 
95.03 
95.04 
9505 
95.06 
95.07 
95.08 
95.09 

96 
96.01 

97 
97.01 



NOSE/ THROAT DISEASES 

acute nose/throat infection (e.g., common cold) 

nasal polyps/allergic rtiinitis (e.g., hay fever) 

chronic sinusitis 

larynx/vocal cord diseases 

paralysis of vocal cords/larynx 

disorders of teeth, gum, and jaw (e.g., periodontitis, gingivitis) 

other diseases of upper respiratory system 

salivary gland diseases 

oral soft tissue/tongue/jav^ disorders 

EMPHYSEMA/CHRONIC BRONCHITIS 
emphysema/chronic bronchitis 

OTHER BRONCHITIS 
other bronchitis 



599 


16,074 


819 


125 


76,452 


4,450 


37 


233 


23,138 


3,799 


55 


219 


20,774 


4,690 


73 


223 


2,141 


9,523 


466 


226 


551 


21,675 


1,382 


150 


5,106 


6,443 


191 


211 


12,132 


5,530 


111 


221 


1,824 


7,112 


428 


257 


4,714 


6,595 


198 


206 


4,511 


20,230 


332 


110 


80,841 


9,585 


61 


180 


1,553 


15,763 


433 


103 


74,211 


5,968 


46 


208 



dcg\finaMableN1Mmd 



TABLE H-1 I 

1992 MEDICARE PROGRAM EXPENDITURES AND 1992 FREQUENCY OF ENROLLEES FOR 
CONCURRENT PRINCIPAL INPATIENT DIAGNOSTIC GROUPS (UPPER CASE LABELS) 
AND HOSPITAL AND PHYSICIAN DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXG 



Label 



DISEASES OF THE RESPIRATORY SYSTEM 



(continued) 



98 VIRAL PNEUMONIA/INFLUENZA 

98.01 viral pneumonia 

98.02 influenza 

99 GRAM-NEGATIVErarrAPHYLOCOCCUS PNEUMONIA 

99 01 gram-negative/staph pneumonia 

100 BACTERIAL PNEUMONIA 

100.01 pneumococcal and other specific bacterial pneumonia 

100.02 ottier and unspecified pneumonia 

101 ASTHMA 
101.01 asttima 

102 LUNG DISEASES DUE TO EXTERNAL AGENTS 

102.01 bronchiectasis, lung diseases due to specified external agent (e.g., black lung disease) 

102.02 aspiration pneumonia 

102.03 respiratory conditions due to other and unspecified external agents/postinflammatory fibrosis 



103 PLEURISY/PNEUMOTHORAX 
103.01 pleurisy/pneumothorax 



104 OTHER LUNG DISEASE 

104.01 empyema/abscessoftung 

104.02 pulmonary congestion/hypostasis 

104.03 acute lung edema not elsewhere specified 

104.04 post trauma/surgery pulmonary insufficiency 

104.05 other lung disease 

105 RESPIRATORY FAILURE/ARREST 

105.01 respiratoryfailure 

105.02 respiratory arrest 

DISEASES OF THE GENITOURINARY SYSTEIVI 

106 REr>IAL FAILURE 

106.01 nephritis, dialysis encounter 

106.02 acute renal failure 

106.03 chronic renal failure 

106.04 renal failure, unspecified 

106.05 impaired renal function 

107 KIDNEY INFECTION 
107.01 kidney infection 

108 RENAL/URETERAUBLADDER CALCULUS 
108.01 renal/ureteral/bladder calculus (e.g., kidney stones) 

109 OTHER RENAL/URETERAL DISEASES 

109.01 urethral stricture 

109.02 hydronephrosis/other renal/urethral disorders 

1 10 OTHER URIf^RY TRACT INFECTIONS 
1 1 0.01 cystitis, other urinary tract infections 

111 OTHER URINARY DISORDERS 
111.01 other urinary disorders 

112 PROSTATEH-ESTICULAR/PENILE DISORDERS 

1 12.01 hyperplasia of prostate 

112.02 other prostatic disorders 

1 12.03 penis/testis/male genital organs disorders 







Standard 


Coefficient 




Mean 


Error 


of Variation 


Frequency* 


Expenditures" 


of Mean 


(X 100) 


262 


15,319 


1,813 


192 


2.564 


16,293 


477 


148 


8,261 


7.096 


173 


222 


2,155 


28.506 


666 


108 


3,985 


30,787 


658 


135 


9,277 


19,236 


229 


115 


4,033 


18,730 


414 


140 


41,993 


15,328 


119 


159 


1,575 


17,748 


570 


128 


23,151 


7,848 


98 


190 


1,681 


32,513 


764 


96 


3,166 


10,432 


317 


171 


3,790 


31,292 


622 


122 


7,313 


12,952 


240 


158 


731 


24,174 


836 


94 


18,772 


22.763 


210 


126 


673 


30,528 


1,422 


121 


890 


23,840 


1,178 


147 


12,515 


17,709 


233 


147 


3,176 


27,583 


591 


121 


1,855 


42,967 


1,164 


117 


28,408 


17,924 


152 


143 


1,746 


37,674 


1,101 


122 


24,115 


21,035 


207 


153 


4,212 


40,009 


791 


128 


952 


28,878 


1,234 


132 


2,931 


17,830 


453 


138 


4,696 


33,360 


632 


130 


6,185 


20,341 


389 


151 


6,208 


19,463 


372 


151 


1,471 


12,887 


503 


150 


614 


14,476 


649 


111 


4,272 


11,247 


253 


147 


802 


10,899 


379 


99 


7,052 


8,893 


189 


178 


347 


17,757 


847 


89 


5,866 


8,100 


183 


173 


16,744 


13,640 


158 


150 


3,755 


21,030 


347 


101 


88,343 


9,108 


55 


180 


587 


16,852 


799 


115 


29,781 


9,292 


90 


168 


3,345 


10,266 


216 


122 


48.567 


5,327 


51 


213 


15,857 


5,347 


79 


187 


8,631 


6,521 


137 


196 



dcgTifiaMableh-l^md 



TABLE H-1 

1992 MEDICARE PROGRAM EXPENDITURES AND 1992 FREQUENCY OF ENROLLEES FOR 
CONCURRENT PRINCIPAL INPATIENT DIAGNOSTIC GROUPS (UPPER CASE LABELS) 
AND HOSPITAL AND PHYSICIAN DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXG 



Label 



DISEASES OF THE GENITOURINARY SYSTBVI 



(continued) 



1 13 DISEASES OF FEMALE GENITAL ORGANS 

1 13.01 diseases of female pelvic OTQans, including peMo inflammatory disease, endometriosis, 
ovarian cyst 

11 3.02 vaginal and cervical diseases 

1 1 3.03 other diseases of female genital organs 

1 13.04 female stress incontinence 

113.05 menopausal and postmenopausal disorders 

114 GENITAL PROLAPSE 
114.01 genital prolapse 

PREGNANCY-RELATED CONDITIONS 



Frequency* 



684 
5,018 

16,212 

10,033 

3,998 

27,600 

1,111 
7,565 



Mean 
Expenditures" 



11,532 
3,645 

4,457 
6,702 
6.084 
3,210 

6,725 
4.257 



Standard 

Error 
of Mean 



564 
208 

79 
126 
156 

46 

180 
93 



Coefficient 

of Variation 

(X 100) 



128 
171 

227 
188 
162 
235 

89 
190 



115 PREGNANCY/PERINATAL CONDITIONS 

115.01 pregnancy/birth complications, mottier/cfiild 

1 1 5.02 pregnancy v^itti atxjrtive outcome 

115.03 normal pregnancy/deliveiy 

DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE 



120 


7,175 


805 


123 


3,896 


10.675 


322 


188 


174 


11.327 


1.661 


193 


361 


7.175 


746 


197 



116 DERMATOLOGICAL DISORDERS 

116.01 cellulitis/atjscess/otfier local skin infection 

1 1 6.02 bullous dermatoses 

117 CHRONIC ULCER OF SKIN 
1 17.01 chronic ulcer of skin 

1 18 OTHER DEMATOLOGICAL DISORDERS 

1 18.01 dermatitis due to internal agent 

1 18.02 psoriasis and similar disorders 

118.03 other dermatosis 

118.04 diseases of nail (e.g.. ingrown toenail) 

1 1 8. 05 other dermatological disorders 



2,383 


17,987 


395 


107 


43.600 


8,403 


76 


188 


726 


8,353 


570 


184 


1.132 


32.993 


790 


81 


21,094 


13,887 


149 


156 


205 


17.075 


1,052 


88 


1,660 


11,194 


481 


175 


4,939 


4,896 


164 


236 


50,974 


3445 


34 


224 


39,841 


6,879 


65 


189 


89,143 


4,710 


35 


222 



CONGENITAL ANOMALIES 

119 CONGENITAL ANOMALIES 

119.01 spina bifida, other congenital anomalies of nervous system 

119.02 congenital anomafes of eye 

119.03 congenital anomalies of cardiac/circulatory systems 

1 1 9.04 congenital anomalies of musculoskeletal/limb 

1 1 9.05 congenital anomalies of skin 

1 19.06 Down's syndrome and ottier chromosomal anomalies 

1 1 9.07 other congenital anomalies 

SYMPTOMS. SIGNS. ILL-DEFINED CONDITIONS 



167 


24,261 


1.659 


88 


1,228 


12,643 


556 


154 


2,186 


4.845 


251 


242 


8,271 


12,741 


235 


168 


5,533 


8,382 


201 


179 


2,792 


5.149 


211 


216 


727 


3.795 


433 


308 


6,448 


10,211 


231 


181 



120 GENERAL SYMPTOMS 

120.01 somatic/segmental dysfunctran 

120.02 dizziness and giddiness 

120.03 malaise and fatigue 

120.04 other general symptoms 

121 COMA/ SYNCOPE 

121.01 coma 

121.02 syncope (fainting) and collapse 

122 FEVER 
122.01 fever 

123 RESPIRATORY/OTHER CHEST SYMPTOMS 

123.01 dyspnea (labored breathing)/other respiratory abnormalities 

123.02 hemoptysis (coughing up blood) 

123.03 cough 

123.04 respiratory/other chest symptoms 



983 


19.244 


686 


112 


11,152 


3.968 


84 


223 


34,231 


6.096 


64 


195 


37,897 


8.075 


74 


177 


127,236 


8.233 


44 


189 


2,235 


13.450 


345 


121 


3.590 


21.579 


524 


145 


19.876 


10.347 


106 


145 


406 


22.211 


1,126 


102 


14.288 


18,289 


214 


140 


476 


16,761 


1,050 


137 


59.523 


12,949 


85 


160 


2.925 


13564 


394 


157 


27.475 


7,329 


84 


190 


31.743 


12,014 


107 


159 



10 

dcg\fmaMableh-1Vmd 



TABLE H-1 

1992 MEDICARE PROGRAM EXPENDITURES AND 1992 FREQUENCY OF ENROLLEES FOR 
CONCURRENT PRINCIPAL INPATIENT DIAGNOSTIC GROUPS (UPPER CASE LABELS) 
AND HOSPITAL AND PHYSICIAN DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXG 



Label 



SYMPTOMS, SIGNS, ILL-DEFINED CONDITIONS (continued) 

124 CARDIOVASCULAR SYMPTOMS 

124.01 chest pain 

124.02 other cardiovascular symptoms 

125 URINARY SYSTEM/ABDOMINAL-PELVIS SYMPTOMS 

125.01 retention of urine 

125.02 irxxintinence/urethral discharge 

125.03 other urinary system symptoms 

125.04 abdominal/pelvis symptoms 







Standard 


Coefficient 




Mean 


Error 


of Variation 


Frequency* 


Expenditures™ 


of Mean 


(X 100) 


3,424 


11.668 


247 


124 


107,457 


9.511 


49 


169 


25.614 


8,171 


95 


186 


1.087 


15,742 


519 


109 


10,291 


15.427 


197 


129 


9.264 


9.638 


161 


161 


23.292 


7.437 


99 


202 


90.850 


9.493 


56 


178 



INJURY AND POISONING 



126 VERTEBRAL INJURY 

126.01 vertebral fracture without spinal cord injury 

126.02 vertebral fracture with spiral cord injury 

127 FRACTURES OF SKULUFACE/NASAL BONE 

127.01 fractures of skull/face 

127.02 fractures of nasal bone 

128 PELVIC FRACTURE 
128.01 pelvic fracture 

129 FEMORAL FRACTURE 
129.01 femoral fracture 

1 30 LOWER LIMB FRACTURES 

130.01 fractures of lower limb (e.g.. leg ankle, foot) 

131 OTHER FRACTURES/DISLOCATION 

131.01 shoulder dislocation 

131.02 dislocation of hip 

131.03 dislocation of knee, including cartilage/meniscus tear 

131.04 other dislocations 

131.05 fracture of rib. closed 

131.06 hand/wrist/lower arm fracture 

131.07 other fractures 

1 32 INTERNAL AND/OR OPEN WOUND 

132.01 foreign biody in pharynx/larynx 

132.02 injury to heart/Iung/intrathoracic organs/blood vessels of thorax 

132.03 gastrointestinal/liver/kidneyfepleen/pelvis injury 

132.04 open wound of eye 

132.05 open wound/injury of lower arm 

1 32.06 open wound of other sites 

132.07 traumatic amputation of limb/handffoot/loe 

132.08 cmshing injury 

132.09 foreign body in eye/ear/nose 

133 SPRAINS 
133.01 sprains 

134 CONTUSIONS/ACCIDENTS/INJURY. SUPERFICIAL AND NOS 

134.01 concussion 

134.02 contusion/superficial injury 

134.03 accidental falls 

134.04 suicide/self-inflicted injury 

1 34.05 other accidents 

135 INTRACRANIAL (HEAD) INJURY 
135.01 intracranial (head) injury 

136 BURNS/NERVE. SPINAL CORD INJURIES 

136.01 third degree burns 

136.02 other bums 

136.03 nerve injury, including spinal cord injury without vertebral fracture 

136.04 early complications of trauma 



735 


17.896 


686 


104 


6.005 


11.525 


213 


143 


651 


14.366 


817 


145 


144 


22.502 


2.387 


127 


1,466 


13.464 


641 


182 


789 


8.390 


508 


170 


671 


17.307 


642 


96 


2.677 


14,284 


324 


117 


5.718 


22.846 


220 


73 


12.028 


16.256 


159 


108 


924 


13.564 


421 


94 


8.410 


7.922 


146 


169 


1.368 


15.026 


425 


104 


912 


8,401 


482 


173 


478 


21,276 


1,051 


108 


2,638 


5.780 


173 


154 


17.466 


3,853 


68 


232 


5,028 


9,606 


229 


169 


8.213 


6.756 


133 


178 


9,531 


9.450 


160 


166 


684 


20.299 


856 


110 


2.507 


15.558 


528 


170 


1.125 


18.169 


873 


161 


1.091 


16.946 


795 


155 


893 


8.083 


485 


179 


13.846 


5.675 


98 


204 


16.581 


9.222 


137 


191 


1.480 


24.968 


766 


118 


604 


7,572 


537 


174 


2.376 


4.185 


195 


228 


613 


10.707 


420 


97 


38.616 


5.085 


51 


198 


650 


15.792 


798 


129 


1,262 


10.498 


461 


156 


53,451 


7.513 


59 


182 


11,004 


10.925 


144 


138 


272 


17.650 


1,092 


102 


7.595 


7.918 


158 


174 


452 


26.727 


1,284 


102 


5.375 


13.276 


278 


154 


162 


28.977 


3,314 


146 


277 


14.600 


1,939 


221 


1.978 


8.171 


397 


216 


1.873 


11,044 


421 


165 


1.276 


21.021 


891 


151 



INJURY AND POISONING 



(continued) 



dcgVinaI\Tableh-iymd 



TABLE H-1 

1992 MEDICARE PROGRAM EXPENDITURES AND 1992 FREQUENCY OF ENROLLEES FOR 
CONCURRENT PRINCIPAL INPATIENT DIAGNOSTIC GROUPS (UPPER CASE LABELS) 
AND HOSPITAL AND PHYSICIAN DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXG 



Label 



137 POISONING/TOXIC EFFECTS 

1 37.01 poisoning by prescription or over-the-counter medications 

137.02 poisoning by specified nonmedicinal substances/injury by certain external causes 

137.03 poisoning by other nonmedicinal substances 

137.04 allergy, unspecified 

137.05 adverse effects of conectly prescribed and administered drugs in therapeutic use 

138 COMPLICATIONS OF MEDICAL PROCEDURES AND CARE 

138.01 malfunction of internal orthopedic device/graft 

138.02 infection/inflammation due to internal device/graft, transplant failure/rejection 

1 38.03 other complications of certain specified medical procedures 

138.04 other complications of medical and surgical procedures, nee, 
(e.g., post operative infection) 

133 05 misadventure or abnomial reaction/complication of patient during sugery or medical care 







Standard 


Coefficient 




Mean 


Error 


of Variation 


Frequency* 


Expenditures** 

17.811 


of Mean 


(x100) 


882 


657 


110 


4,660 


14,766 


306 


142 


3,091 


11,075 


338 


170 


1,749 


3,642 


194 


223 


4,972 


4.933 


140 


200 


13,316- 


11.578 


147 


146 


4,439 


27,768 


389 


93 


1,819 


18.019 


436 


103 


1,913 


30.948 


805 


114 


7,359 


22,602 


317 


120 


17,710 


23.191 


206 


118 



1.270 



22,014 



600 



97 



FACTORS INFLUENCING HEALTH STATUS/CONTACT WITH HEALTH SERVICES (V-CODE) 

139 ORGAN REPLACEMENT/TRANSPLANT/POST-SURGICAL STATES 

139.01 kidney, heart, heart valve (human/animal tissue), lung, liver transplant 

139.02 other organ transplant 

139.03 heart, heart valve replacement by artificial device 

139.04 joint replacement 

139.05 other organ replacement 

139.06 artificial opening statua/attention 

139.07 postsurgical states, eye 

139.08 other postsurgical states, including dialysis status 

139.09 aspirator, respirator, other machine dependence 

140 REHABILITATION PROCEDURES 
140.01 rehabilitation procedures 

141 RADIOTHERAPY 
141.01 radiation therapy 

142 CHEMOTHERAPY 
142.01 chemotherapy 

143 HISTORY OF DISEASE/AFTERCARE/SCREENING 

143.01 infectious disease contact/carrier 

143.02 vaccination, medical exam, other preventive 

1 43. 03 history of malignant nec^itasm 

143.04 history of mental disorder/other disease 

143.05 history of drug allergy/other health hazard 

143.06 family history of disease 

143.07 problems of internal organs/external sites 

143.08 elective surgery 

1 43 09 prothesis/other device fitting, adjustment 

143.10 other orthopedic aftercare 

143.11 aftercare 

143.12 donor 

143.13 household/family/other psychosocial circumstances 

143.14 care not delivered 

143.15 administrative/consultation 

143.16 screening for malignant neoplasm 

1 43. 1 7 screening/observation/special exams 



583 


29.464 


1,085 


89 


539 


22.365 


1,596 


166 


895 


8,164 


630 


231 


2,397 


14.676 


489 


161 


5,949 


15,966 


218 


105 


416 


17,552 


1,341 


156 


4.398 


25,253 


500 


131 


298 


13.478 


816 


105 


21.008 


14.947 


142 


138 


380 


71,286 


4.681 


128 


4,340 


31,800 


349 


72 


10,961 


19,601 


208 


111 


143 


31,087 


1,762 


69 


4,266 


15,246 


269 


115 


935 


34,281 


772 


69 


3,437 


20,596 


382 


109 


1,218 


24,426 


701 


100 


674 


4,686 


347 


192 


38,764 


4.297 


50 


230 


22.850 


9.230 


98 


160 


6,998 


10.849 


194 


150 


6,696 


7.440 


174 


191 


4,769 


4,167 


135 


223 


1,244 


9.656 


518 


189 


321 


8,360 


707 


152 


2,091 


12.765 


454 


163 


2,468 


13,060 


326 


124 


6,543 


13.681 


264 


156 


343 


19.230 


1,206 


116 


539 


9.812 


606 


143 


1.831 


12,374 


403 


140 


3.457 


8.148 


259 


187 


26.841 


3.141 


47 


247 


267,301 


6,820 


26 


200 



• Unweighted. 

** WetgMed by fraction of year beneficiary was aive and eigibJe for Medicare. 



SOUI^CE: 1992 (expenditures) and 1992 (diagnoses) Me<tcaredalms. 



12 
dcyWnalMableb-nmd 



TABLE H-2 

REGRESSION OF 1992 MEDICARE PROGRAM EXPENDITURES ON 1992 HOSPITAL AND PHYSICIAN 
(ALL) DIAGNOSIS DIAGNOSTIC GROUPS 









SUM OF 


MEAN 






SOURCE 




BE 


SQUARES 


SQUARE 


F VALUE 


PROB>F 


MODEL 




442 


3.87E+13 


8.75E+10 


1742.329 


0.0001 


ERROR 




679,745 


3.41 E+1 3 


50202860 






C TOTAL 




680,187 


7.28E+13 








ROOT MSE 


7,085 


R-SQUARE 


0.5312 






DEP MEA^ 




3,783 


ADJ R-SQ 


0.5309 






C.V. 




187 
















PARAMETER 


STANDARD 


T FOR HO: 


VARIABLE 


ADDXG 


VARIABLE 


OF ESTIMATE 


ERROR 


PARAMETER=0 


PROB > ITI 




Intercept 




1 ($150) 


$28 


-5.38 


0.0001 


1.01 


CNS Infection 




1 1,615 


170 


9.51 


0.0001 


2.01 


septicemia/shock 




1 6,302 


82 


77.28 


0.0001 


3.01 


HIV/AIDS 




1 4,296 


334 


12.87 


0.0001 


4.01 


bacterial enteritis 




1 2,869 


191 


15.04 


0.0001 


4.02 


viral enteritis 




1 17 


151 


0.11 


0.9114 


4.03 


other intestinal infections 




1 787 


146 


1.94 


0.0526 


4.04 


tuberculosis 




1 273 


158 


1.73 


0.0846 


4.05 


strep throat/scarlet fever 




1 -656 


207 


-3.17 


0.0015 


4.06 


other bacterial infections 




1 1.634 


218 


7.49 


0.0001 


4.07 


bact inf in other diseases 




1 2,770 


73 


37.86 


0.0001 


4.08 


herpes zoster 




1 -67 


85 


-0.79 


0.4293 


4.09 


herpes simplex 




1 317 


157 


2.02 


0.0433 


4.10 


hepatitis 




1 1.492 


265 


5.63 


0.0001 


4.11 


other viral infections 




1 -213 


62 


-3.43 


0.0006 


4.12 


late syphilis, symptomatic 




793 


400 


1.98 


0.0475 


4.13 


dermatophytosis 




1 -354 


35 


-10.03 


0.0001 


4.14 


thrush 




1,730 


194 


8.93 


0.0001 


4.15 


mycoses, miscellaneous 




1 1,444 


131 


10.99 


0.0001 


4.16 


other infections 




480 


77 


6.20 


0.0001 


5.01 


infection late effects 




902 


277 


3.26 


0.001 1 


5.02 


cerebrovasc dis late effects 




773 


77 


10.05 


0.0001 


5.03 


injury late effects 




1.414 


172 


8.23 


0.0001 


6.01 


cancer of mouthAongue 




1.940 


226 


8.60 


0.0001 


6.02 


cancer of pharynx 




1,357 


283 


4.80 


0.0001 


6.03 


cancer of larynx 




1.155 


234 


4.94 


0.0001 


6.04 


other resp./intrathoracic cancer 




983 


324 


3.03 


0.0024 


7.01 


cancer of esophagus 




3,490 


KS 


10.74 


0.0001 


7.02 


cancer of stomach 




3,749 


241 


15.53 


0.0001 


7.03 


cancer of small bowel 




1,945 


274 


7.11 


0.0001 


7.04 


cancer of liver 




1.679 


245 


6.84 


0.0001 


7.05 


cancer of pancreas 




3.780 


»7 


14.73 


0.0001 


7.06 


other cancer of digestive organs 




647 


292 


2.22 


0.0265 


8.01 


colon cancer 




1 1.183 


103 


11.53 


0.0001 


9.01 


rectal cancer 




1 1.014 


113 


8.98 


0.0001 


10.01 


lung cancer 




1 1.735 


101 


17.24 


0.0001 


11.01 


breast cancer 




1 -172 


67 


-2.58 


0.0100 


12.01 


lymphoma/Karposi's sarcoma 




1 1,626 


127 


12.79 


0.0001 


12.02 


multiple myeloma 




1 1,305 


219 


5.95 


0.0001 


12.03 


lymphoid leukemia 




519 


196 


2.65 


0.0081 



1 

dcg\rinal\Tableh-2\nab 



TABLE H-2 (continued) 

REGRESSION OF 1992 MEDICARE PROGRAM EXPENDITURES ON 1992 HOSPITAL AND PHYSICIAN 
(ALL) DIAGNOSIS DIAGNOSTIC GROUPS 







PARAMETER 


STANDARD 


T FOR HO: 


VARIABLE 


ADDXG 


VARIABLE OF ESTIMATE 


ERROR 


PARAMETER=0 


PROB > ITI 


12.04 


myeloid leukemia 


1 6.153 


317 


19.38 


0.0001 


12.05 


other leukemia 


1 2,473 


244 


10.13 


0.0001 


13.01 


cancer of uteojs 


1 584 


168 


3.48 


0.0005 


13.02 


cancer of cervix/female genital 


1 803 


204 


3.94 


0.0001 


14.01 


cancer of placenta/uterine adnexa 


1 1,725 


210 


8.20 


0.0001 


15.01 


prostate cancer 


1 736 


60 


12.24 


0.0001 


15.02 


cancer of testis/male genital 


1 1,210 


363 ' 


3.33 


0.0009 


16.01 


cancer of bladder/urinary organs 


1 549 


96 


5.70 


0.0001 


17.01 


cancer of the eye 


1 78 


393 


0.20 


0.8434 


17.02 


cancer of the brain/nervous system 


1 2,279 


156 


14.64 


0.0001 


17.03 


benign neoplasm brain/nervous 


1 1,128 


180 


6.28 


0.0001 


18.01 


cancer of bone 


1 1,267 


200 


6.33 


0.0001 


18.02 


cancer of connective tissue 


1 983 


219 


4.51 


0.0001 


18.03 


melanoma 


1 147 


181 


0.81 


0.4184 


18.04 


other skin cancer 


1 45 


50 


0.90 


0.3669 


18.05 


thyroid/endocrine cancer 


1 225 


290 


0.77 


0.4389 


18.06 


other/ill-defined site cancer 1 


1 896 


84 


10.61 


0.0001 


19.01 


secondary cancer of lymph node 1 


4,337 


150 


28.89 


0.0001 


19.02 


secondary cancer of respiratory 1 


4,645 


122 


38.14 


0.0001 


19.03 


secondary cancer of other site 1 


3,957 


100 


39.71 


0.0001 


19.04 


disseminated cancer 1 


1,896 


191 


9.95 


0.0001 


20.01 


benign neoplasm of digestive system 1 


-37 


56 


-0.66 


0.5119 


20.02 


benign neoplasm of resp system 1 


218 


196 


1.11 


0.2655 


20.03 


benign neoplasm of skin 1 


-83 


55 


-1.50 


0.1333 


20.04 


benign neoplasm of breast 1 


-338 


32 


-10.72 


0.0001 


20.05 


benign neoplasm of urinary 1 


359 


232 


1.55 


0.1221 


20.06 


benign neoplasm of eye 


45 


212 


0.21 


0.8330 


20.07 


other tjenign neoplasms 1 


271 


64 


4.23 


0.0001 


21.01 


cancer In situ of digestive organs 1 


1,5// 


183 


8.61 


0.0001 


21.02 


cancer In situ of resp system 1 


489 


244 


2.00 


0.0452 


21.03 


cancer In situ of other sites 1 


1,076 


107 


10.10 


0.0001 


21.04 


neoplasm of uncertain behavior 1 


982 


90 


10.85 


0.0001 


21.05 


neoplasm of uncertain behavior 1 


235 


67 


3.53 


0.0004 


21.06 


unspecified neoplasm 1 


533 


51 


10.37 


0.0001 


2Z01 


diabetes vnthout comp. 1 


66 


29 


2.26 


0.0236 


23.01 


diabetes w/acute comp. 1 


647 


131 


4.96 


0.0001 


24.01 


diabetes with renal manifestation 1 


907 


184 


4.93 


0.0001 


24.02 


diabetes w/other specified compl. 1 


1,065 


77 


13.89 


0.0001 


24.03 


diabetes w/unspeclfied compile. 1 


1,463 


61 


23.79 


0.0001 


25.01 


hypoglycemic coma 1 


1,558 


282 


5.52 


0.0001 


25.02 


other hypoglycemia 


508 


115 


4.43 


0.0001 


26.01 


disorders of fluid/electrolyte 1 


2,309 


38 


60.68 


0.0001 


27.01 


goiter 1 


239 


113 


2.11 


0.0347 


27.02 


thyrotoxicosis 


-98 


95 


-1.03 


0.3023 


27.03 


thyroid disorders 1 


-163 


38 


-4.24 


0.0001 


27.04 


adrenal gland disorders 1 


1,053 


185 


5.70 


0.0001 


27.05 


ovarian dysfunction 1 


1 -62 


171 


-0.36 


0.7165 


27.06 


testicular dysfunction 1 


1 75 


325 


0.23 


0.8183 


27.07 


other endocrine disorders 1 


1 -914 


132 


-6.93 


0.0001 


27.08 


misc. endocrine disorders 1 


1 750 


142 


5.27 


0.0001 


27.09 


protein-calorie malnutrition 1 


1 5,750 


95 


60.50 


0.0001 


27.10 


vitamin/other nutritional deficiency 


-145 


97 


-1.50 


0.1332 


27.11 


disorders of lipoid metabolism 


-309 


26 


-11.85 


0.0001 



dcg\final\Tableh-2\nab 



TABLE H-2 (continued) 

REGRESSION OF 1992 MEDICARE PROGRAM EXPENDITURES ON 1992 HOSPITAL AND PHYSICIAN 
(ALL) DIAGNOSIS DIAGNOSTIC GROUPS 







PARAMETER 


STANDARD 


T FOR HO: 


VARIABLE 


ADDXG 


VARIABLE DF ESTIMATE 


ERROR 


PAFJAMETER=0 


PROS > ITI 


27.12 


disorders of plasma protein met 


1 448 


176 


2.54 


0.0110 


27.13 


disorders of mineral metabolism 


1 1,110 


115 


9.63 


0.0001 


27.14 


metabolism disorders nec/nos 


1 -61 


167 


-0.37 


0.7145 


27.15 


other hyperalimentation 


1 586 


338 


1.73 


0.0829 


27.16 


obesity/localized adiposity 


I 862 


81 


10.64 


0.0001 


28.01 


acute pancreatitis 


1 1,435 


145 


9.87 


0.0001 


28.02 


chronic pancreatitis/other pancr. 


1 1,213 


140 


8.67 


0.0001 


29.01 


end stage liver disorders 


1 4,561 


238 


19.20 


0.0001 


29.02 


esophageal varices 


1 3,642 


329 


11.08 


0.0001 


30.01 


cirrhosis 


1 921 


156 


5.91 


0.0001 


30.02 


other liver disorders 


1 -60 


87 


-0.69 


0.4893 


31.01 


disease of esophagus 


55 


46 


1.18 


0.2382 


32.01 


ulcer w/o perforation 


358 


53 


6.82 


0.0001 


32.02 


ulcer with perforation 


2,844 


234 


12.17 


0.0001 


33.01 


pyloric/duodenal obstruction i 


1 2,390 


261 


9.16 


0.0001 


33.02 


gastritis/oth gastric disorder 1 


1 149 


29 


5.08 


0.0001 


34.01 


appendicitis 


1,555 


249 


6.25 


0.0001 


35.01 


abdominal hernia/complicated 


930 


178 


5.22 


0.0001 


36.01 


abdominal hernia/uncomplicated 1 


28 


45 


0.64 


0.5254 


37.01 


regional enteritis 1 


890 


191 


4.66 


0.0001 


37.02 


idiopathic proctocolitis 1 


33 


183 


0.18 


0.8567 


38.01 


intestinal obstruction 1 


2,484 


68 


36.34 


0.0001 


38.02 


peritonitis 1 


7,183 


223 


32.22 


0.0001 


38.03 


other peritoneal disorders 


3,043 


182 


16.70 


0.0001 


39.01 


divercula of intestine 


-160 


43 


-3.75 


0.0002 


40.01 


hemorrtioids 1 


-78 


56 


-1.39 


0.1632 


40.02 


anal/rectal disorders 


41 


53 


0.76 


0.4455 


40.03 


intestinal abcess, ulceration, 


1,941 


126 


15.40 


0.0001 


40.04 


other intestinal disorders 1 


38 


46 


0.83 


0.4092 


41.01 


cholelithiasis 1 


336 


88 


3.82 


0.0001 


41.02 


biliary tract disease 1 


2,984 


175 


17.01 


0.0001 


41.03 


other gallbladder disorders 1 


1,207 


81 


14.94 


0.0001 


42.01 


gastrointestinal hemorrage 1 


1,103 


50 


22.00 


0.0001 


43.01 


gout/crystal arthropathy 1 


-308 


65 


-4.78 


0.0001 


43.02 


other arthropathy/joint disorders 


90 


26 


3.42 


0.0006 


44.01 


connective tissue disease 


8 


101 


0.08 


0.9353 


44.02 


rheumatoid arthritis 1 


259 


61 


4.22 


0.0001 


44.03 


inflammatory spondylopathies 1 


237 


160 


1.48 


0.1398 


44.04 


polymyalgia rheumatica 1 


-94 


116 


-0.81 


0.4191 


45.01 


arthropathy w/infection 1 


1,528 


206 


7.42 


0.0001 


45.02 


osteomyelitis 1 


2,272 


124 


18.27 


0.0001 


46.01 


osteoarthrosis 1 


16 


25 


0.64 


0.5211 


47.01 


back disorders 1 


-45 


28 


-1.58 


0.1133 


48.01 


disorders of soft tissue 1 


58 


27 


2.17 


0.0301 


49.01 


osteoporosis 1 


460 


56 


8.22 


0.0001 


49.02 


other bone disorders 1 


364 


52 


7.00 


0.0001 


49.03 


foot disorders 1 


-56 


62 


-0.90 


0.3664 


49.04 


oth acquired limb deformities 1 


1,335 


118 


11.35 


0.0001 


50.01 


anemia 1 


1.031 


33 


31.47 


0.0001 


51.01 


hereditary hemolytic anemias 1 


1,316 


232 


5.63 


0.0001 


51.02 


acquired hemolytic anemia 1 


770 


294 


2.62 


0.0089 


51.03 


aplastic anemia 1 


3,492 


163 


21.39 


0.0001 


51.04 


coagulation defects 1 


603 


92 


6.56 


0.0001 


51.05 


purpura/ throbocytopathy 1 


2.366 


113 


20.99 


0.0001 



dcg\final\Tableh-2\nab 



TABLE H-2 (continued) 

REGRESSION OF 1992 MEDICARE PROGRAM EXPENDITURES ON 1992 HOSPITAL AND PHYSICIAN 
(ALL) DIAGNOSIS DIAGNOSTIC GROUPS 







PARAMETER 


STANDARD 


T FOR HO: 


VARIABLE 


ADDXG 


VARIABLE OF ESTIMATE 


ERROR 


PARAMETER=0 


PROB > ITI 


51.06 


white blood cell disorders 


1 1,444 


103 


13.96 


0.0001 


51.07 


immune disorders 


» 2,607 


269 


9.68 


0.0001 


51.08 


other blood disease 


1 -226 


91 


-2.48 


0.0131 


52.01 


senile/presenile psychoses 


1 -78 


60 


-1.29 


0.1970 


52.02 


other organic psychoses cond. 


1 1,107 


135 


8.18 


0.0001 


52.03 


cerebral degeneration/Alzheimer's 


1 311 


64 


4.85 


0.0001 


52.04 


senility without psychosis 


1 -399 


198 


-2.02 


0.0436 


53.01 


alcoholic psychoses 


1 514 


??9 


2.25 


0.0248 


53.02 


drug psychoses 


1 1.873 


22b 


8.31 


0.0001 


54.01 


transient organic mental disorders 


2,176 


109 


20.00 


0.0001 


54.02 


hallucinations 


709 


262 


2.71 


0.0067 


55.01 


schizophrenic disorders ' 


1 2,256 


82 


27.51 


0.0001 


56.01 


manic and depressive disorders 


1 2,242 


67 


33.29 


0.0001 


57.01 


paranoid states 1 


1 1.531 


246 


6.22 


0.0001 


57.02 


other nonorganic psychoses 1 


435 


65 


6.67 


0.0001 


58.01 


neurotic disorders 1 


90 


45 


1.97 


0.0486 


59.01 


alcohol dependence 1 


1.553 


137 


11.36 


0.0001 


59.02 


drug dependence 1 


3.363 


238 


14.15 


0.0001 


59.03 


non-dependent abuse of drugs 1 


922 


99 


9.36 


0.0001 


60.01 


personality disorders 1 


2.752 


165 


16.68 


0.0001 


60.02 


sexual disorders 


-224 


192 


-1.16 


0.2456 


60.03 


psychophysiologic disorders 1 


-172 


236 


-0.73 


0.4654 


60.04 


acute reaction to stress 


-289 


174 


-1.66 


0.0973 


60.05 


adjustment reaction 


2.206 


114 


19.39 


0.0001 


60.06 


nonpsychotic brain syndrome 


-117 


81 


-1.44 


0.1493 


60.07 


other depression 


574 


64 


9.00 


0.0001 


60.08 


behavior disorder 1 


1.082 


270 


4.00 


0.0001 


60.09 


developmental/biehavioral disord. 1 


892 


244 


3.66 


0.0003 


60.10 


menial retardation 1 


-439 


123 


-3.58 


0.0003 


60.11 


other mental disorders 


159 


154 


1.03 


0.3027 


61.01 


headaches 


42 


46 


0.91 


0.3637 


62.01 


Parkinson's disease 1 


166 


77 


2.15 


0.0313 


62.02 


extrapyramidal disease 


422 


118 


3.57 


0.0004 


62.03 


anterior horn cell disease 1 


1.^9 


330 


3.91 


0.0001 


62.04 


other spinal cord disease 1 


2.892 


213 


13.55 


0.0001 


62.05 


autonomic nerve disorder 1 


1.448 


189 


7.67 


0.0001 


62.06 


other CNS diseases 1 


110 


272 


0.41 


0.6858 


63.01 


MS, other CNS dymelination 1 


945 


177 


5.34 


0.0001 


63.02 


infantile cerebral palsy 1 


205 


229 


0.89 


0.3711 


63.03 


quadriplegia 1 


3.931 


-ssa. 


13.96 


0.0001 


63.04 


paraplegia 1 


3.478 


243 


14.33 


0.0001 


63.05 


Cauda equina syndrome 1 


1,135 


124 


9.13 


0.0001 


63.06 


other paralytic disorders 1 


1.873 


200 


9.36 


0.0001 


63.07 


nen/ous/musculoskeletal system 1 


8S7 


72 


11.87 


0.0001 


63.08 


other central nervous system dis. 


1.263 


200 


6.30 


0.0001 


64.01 


seizure disorders 1 


730 


60 


12.17 


0.0001 


65.01 


trigeminal nerve disorder 1 


136 


191 


0.71 


0.4753 


65.02 


facial nerve disorders 1 


-51 


177 


-0.29 


0.7754 


65.03 


root/plexus disorders 1 


186 


284 


0,66 


0.5115 


65.04 


root/plexus lesions 1 


819 


297 


2.76 


0.0058 


65.05 


other cranial nerve disorders 


457 


392 


1.17 


0.2427 


65.06 


neuropathy of upper limb 1 


1 188 


89 


2.12 


0.0339 


65.07 


neuropathy of leg 1 


1 -82 


89 


-0.93 


0.3548 


66.01 


peripheral neuropathy 1 


1 26 


97 


0.27 


0.7862 



clcg\rinal\Tabieh-2\nab 



TABLE H-2 (continued) 

REGRESSION OF 1992 MEDICARE PROGRAM EXPENDITURES ON 1992 HOSPITAL AND PHYSICIAN 
(ALL) DIAGNOSIS DIAGNOSTIC GROUPS 







PARAMETER 


STANDARD 


T FOR HO: 


VARIABLE 


ADDXG 


VARIABLE DF ESTIMATE 


ERROR 


PARAMETER=0 


PROB > IT! 


66.02 


InflammatoryAoxic neuropathy 


1 1,497 


133 


11.25 


0.0001 


66.03 


myoneural disorders 


1 758 


285 


2.66 


0.0079 


66.04 


muscular dystrophies 


1 2,274 


250 


9.10 


0.0001 


66.05 


other neuropathy 


1 153 


251 


0.61 


0.5419 


67.01 


other brain disorders 


1 ■ 2,815 


100 


28.23 


0.0001 


68.01 


rheumatic fever/heart disease 


1 462 


119 


3.89 


0.0001 


68.02 


mitral or aortic valve disease 


1 649 


45 


14.43 


0.0001 


68.03 


mitral/aortic valve disorders 


1 1 ,286 


92 


13.98 


0.0001 


69.01 


essential hypertension 


1 93 


19 


4.77 


0.0001 


69.02 


hypertensive heart disease 


1 91 


45 


2.01 


0.0444 


70.01 


malignant hypertension 


1 45 


54 


0.82 


0.4120 


70.02 


malignant hypertensive heart dis. 


1 299 


132 


2.27 


0.0230 


70.03 


hypertensive heart and renal dis. 1 


1 709 


121 


5.86 


0.0001 


70.04 


secondary hypertension 1 


359 


269 


1.34 


0.1817 


70.05 


hypertension encephalopathy 1 


888 


211 


4.20 


0.0001 


71.01 


myocardial infarction 1 


1,445 


76 


18.91 


0.0001 


71.02 


old myocardial infarction 1 


731 


72 


10.11 


0.0001 


71.03 


other chronic ischemic heart dis. 1 


116 


26 


4.42 


0.0001 


72.01 


acute myocardial infarction 1 


4,551 


96 


47.55 


0.0001 


73.01 


other acute ischemia 1 


3,507 


56 


62.18 


0.0001 


74.01 


angina pectoris 1 


461 


40 


11.67 


0.0001 


75.01 


pulmonary embolism 1 


1,970 


130 


15.19 


0.0001 


75.02 


other pulmonary heart disease 1 


1,908 


95 


20.10 


0.0001 


76.01 


conduction dis./cardiac dysrhyth. 1 


320 


34 


9.47 


0.0001 


76.02 


premature heart beats 


155 


65 


2.39 


0.0167 


77.01 


atrial arrythmia 


1,066 


40 


26.96 


0.0001 


78.01 


ventric tachycardia 1 


2,741 


106 


25.83 


0.0001 


79.01 


heart arrest/shock 1 


4,470 


100 


44.74 


0.0001 


60.01 


heart failure 1 


653 


34 


19.30 


0.0001 


81.01 


pericarditis, post-MI 1 


2,800 


146 


19.22 


0.0001 


81.02 


acute endo/myocarditis 1 


2,739 


276 


9.94 


0.0001 


81.03 


cardiomyopathy/myocarditis 1 


1,053 


72 


14.70 


0.0001 


81.04 


cardiomegaly 1 


932 


51 


18.17 


0.0001 


81.05 


other heart disease 1 


658 


66 


9.98 


0.0001 


82.01 


cerebral hemorrhage 1 


2,970 


121 


24.62 


0.0001 


83.01 


precerebrai arterial occlusion 1 


738 


59 


12.54 


0.0001 


84.01 


cerebrovascular disease (stroke) 1 


930 


43 


21.41 


0.0001 


84.02 


hemiplegia 


4,398 


97 


45.19 


0.0001 


84.03 


aphasia 1 


2,513 


159 


15.80 


0.0001 


85.01 


transient cerebral ischemia 1 


101 


56 


1.80 


0.0727 


86.01 


atherosclerosis of major vessel 1 


450 


54 


8.26 


0.0001 


86.02 


atherosclerosis/general, ascvd 1 


214 


38 


5.61 


0.0001 


87.01 


aortic aneurysm 


1.316 


90 


14.59 


0.0001 


87.02 


other aneurysm 


2,987 


172 


17.36 


0.0001 


88.01 


arterial emtx>lism and thrombosis 


2,800 


98 


28.45 


0.0001 


89.01 


specified peripheral vascular dis. 1 


1,269 


132 


9.59 


0.0001 


89.02 


Raynaud's syndrome 1 


321 


233 


1.37 


0.1693 


89.03 


peripheral vascular disease 1 


75 


46 


1.64 


0.1017 


89.04 


other arterial disease 1 


1,345 


90 


14.87 


0.0001 


89.05 


disease of capillaries 1 


245 


236 


1.04 


0.2982 


89.06 


vascular insufficiency of intestine 1 


4,127 


194 


21.28 


0.0001 


89.07 


gangrene 1 


7,140 


142 


50.40 


0.0001 


90.01 


thrombophlebitis 


1,382 


66 


20.99 


0.0001 


90.02 


noninfectious lymphatic disorders 1 


401 


186 


2.15 


0.0313 



dcg\rinaMableh-2\nab 



TABLE H-2 (continued) 

REGRESSION OF 1992 MEDICARE PROGRAM EXPENDITURES ON 1992 HOSPITAL AND PHYSICIAN 
(ALL) DIAGNOSIS DIAGNOSTIC GROUPS 







PARAMETER 


STANDARD 


T FOR HO: 


VARIABLE 


ADDXG 


VARIABLE OF ESTIMATE 


ERROR 


PARAMETER=0 


PROB > ITl 


90.03 


hemorrhage nos 


1 3,083 


220 


14.04 


0.0001 


90.04 


compression of vein 


t 843 


239 


3.54 


0.0004 


91.01 


hypotension 


1 1,509 


84 


17.91 


0.0001 


92.01 


superficial phlebitis-leg 


1 172 


165 


1.04 


0.2977 


92.02 


varicose veins 


1 186 


77 


2.43 


0.0151 


92.03 


other circulatory disease 


1 910 


98 


9.27 


0.0001 


92.04 


oth specified circulatory disorders 


1 284 


-82 _ 


3.47 


0.0005 


93.01 


diabetic retinopathy 


1 116 


79 


1.47 


0.1415 


93.02 


proliferative diabetic retinopathy 


1 246 


174 


1.41 


0.1582 


93.03 


endophthalmitis 


1 206 


314 


0.65 


0.5133 


93.04 


retinal disorders 


1 -49 


33 


-1.49 


0.1363 


93.05 


glaucoma 


1 64 


32 


1.99 


0.0463 


93.06 


cataract/lens replacement 





21 


-0.01 


0.9895 


93.07 


disorders of refraction and accommodation 


-122 


49 


-2.49 


0.0127 


93.08 


vitreous hemorrhage 


855 


195 


4.39 


0.0001 


93.09 


other eye disorders 


16 


24 


0.65 


0.5144 


94.01 


impacted cerumen 1 


1 -221 


45 


-4.88 


0.0001 


94.02 


Otis media 1 


8 


58 


0.14 


0.8857 


94.03 


vertiginous syndromes 1 


-215 


69 


-3.12 


0.0018 


94.04 


hearing loss 1 


43 


57 


0.75 


0.4527 


94.05 


other ear disorders 1 


-19 


53 


-0.37 


0.7152 


95.01 


acute nose/throat infection 1 


-342 


29 


-11.81 


0.0001 


95.02 


nasal polyps/allergic rhinitis 1 


-170 


49 


-3.44 


0.0006 


95.03 


chronic sinusitis 1 


•183 


52 


-3.51 


0.0004 


95.04 


larynx/vocal cord diseases 1 


957 


158 


6.07 


0.0001 


95.05 


paralysis of vocal cords/larnyx 1 


4.117 


314 


13.09 


0.0001 


95.06 


disorders of teeth and jaw 1 


231 


101 


2.30 


0.0217 


95.07 


other diseases of upper respir. 1 


-60 


67 


-0.90 


0.3686 


95.08 


salivary gland diseases 1 


462 


168 


2.74 


0.0061 


95.09 


oral soft tissuertongue/jaw dis. 1 


-140 


105 


-1.33 


0.1849 


96.01 


emphysema/chronic bronchitis 1 


448 


30 


14.73 


0.0001 


97.01 


other bronchitis 1 


-361 


30 


-12.07 


0.0001 


98.01 


viral pneumonia 1 


946 


149 


6.37 


0.0001 


98.02 


influenza 1 


-268 


80 


-3.34 


0.0008 


99.01 


gram-negistaph pneumonia 1 


7.281 


129 


56.30 


0.0001 


100.01 


specific bacterial pneumonia 1 


908 


122 


7.44 


0.0001 


100.02 


other pneumonia 1 


1.087 


43 


25.23 


0.0001 


101.01 


asthma 1 


369 


50 


7.31 


0.0001 


102.01 


bronchiectasis, external agent 1 


102 


130 


0.79 


0.4311 


102.02 


aspiration pneumonia 1 


6,086 


137 


44.51 


0.0001 


102.03 


resp cond (ext agent) 1 


305 


87 


3.50 


0.0005 


103.01 


pleurisy/pneumothorax 1 


3.501 


61 


57.41 


0.0001 


104.01 


empyema/abscess 1 


4,382 


251 


17.48 


0.0001 


104.02 


pulmonary congest/hypostasis 1 


1,138 


70 


16.31 


0.0001 


104.03 


acute lung edema nos < 


2.758 


141 


19.59 


0.0001 


104.04 


post trauma pulmonary insufficiency 


12.919 


182 


71.04 


0.0001 


104.05 


other lung disease 


2.273 


48 


47.05 


0.0001 


105.01 


respiratory failure 1 


1 3.509 


55 


63.60 


0.0001 


105.02 


respiratory arrest 


1 12.688 


133 


95.28 


0.0001 


106.01 


nephritis 


1 844 


143 


5.88 


0.0001 


106.02 


acute renal failure 


1 7.066 


129 


54.79 


0.0001 


106.03 


chronic renal failure 


1 1,613 


108 


15.00 


0.0001 


106.04 


renal failure unspecified 


1 405 


107 


3.80 


0.0001 


106.05 


impaired renal function 


1 -494 


191 


-2.59 


0.0097 



dcg\rinal\Tableh-2\nab 



TABLE H-2 (continued) 

REGRESSION OF 1992 MEDICARE PROGRAM EXPENDITURES ON 1992 HOSPITAL AND PHYSICIAN 
(ALL) DIAGNOSIS DIAGNOSTIC GROUPS 



ADDXG 


VARIABLE 


107.01 


kidney infection 


108.01 


renal/ur^eral/bladder calculus 


109.01 


urethral sliicture 


109.02 


hydronephfosis/other renal/dls. 


110.01 


other urinary tract infections 


111.01 


other urinary disorders 


112.01 


hyperplasia of prostate 


112.02 


other prostatic disorders 


112.03 


penls/testis/male gen disorders 


113.01 


diseases of female pelvic organs 


113.02 


vaginal and cervical diseases 


113.03 


other diseases of female genitals 


113.04 


female stress incontinence 


113.05 


menopausal and postmenopausal 


114.01 


genital prt^se 


115.01 


pregnancy/birth complications 


115.02 


abortion 


115.03 


normal pregnancy/delivery 


116.01 


dermatological disorders 


116.02 


bullous dermatoses 


117.01 


chronic ulcer of skin 


118.01 


dermatitis due to internal agents 


118.02 


psoriasis and similar disorders 


118.03 


other dermatosis 


118.04 


diseases of nail 


118.05 


other dermatological disorders 


119.01 


congenital anomalies of nervous 


119.02 


congenital anomalies of eye 


119.03 


congenital anomalies of cardiac 


119.04 


congenital anomalies of muscul. 


119.05 


congenital anomalies of skin 


119.06 


chromosomal anomalies 


119.07 


other congenital anomalies 


120.01 


somatic/segmental dysfunction 


120.02 


dizziness and giddiness 


120.03 


malaise and fatigue 


120.04 


other general symptom 


121.01 


coma 


121.02 


syncope and collapse 


122.01 


fever 


123.01 


dyspnea/other resp abnormalities 


123.02 


hemoptysis 


123.03 


cough 


123.04 


respiratory/other chest symptoms 


124.01 


chest pain 


124.02 


other cardiovascular symptoms 


125.01 


retention of urine 


125.02 


incontinence/urethral discharge 


125.03 


other urinary system symptoms 


125.04 


abdominal/pelvis symptoms 


126.01 


vertebral fracture w/o spinal tract. 


126.02 


vertebral fracture with spinal tract. 


127.01 


fractures of skull/face 


127.02 


fractures of nasal bone 



PARAMETER 


STANDARD 


T FOR HO: 


VARIABLE 


DF ESTIMATE 


ERROR 


PARAMETER=0 


PROB > ITI 


1 -823 


113 


-7.27 


0.0001 


1 398 


88 


4.52 


0.0001 


1 88 


96 


0.91 


0.3609 


1 270 


61 


4.41 


0.0001 


1 380 


29 


13.00 


0.0001 


1 301 


47 


6.45 


0.0001 


1 25 


39 


0.66 


0.5119 


1 -119 


61 


-1.94 


0.0522 


1 44 


80 


0.56 


0.5792 


1 730 


106 


6.88 


0.0001 


1 -26 


59 


-0.44 


0.6627 


1 -10 


75 


-0.14 


0.8920 


1 207 


117 


1.77 


0.0769 


1 -55 


47 


-1.19 


0.2357 


1 151 


85 


1.78 


0.0758 


1 919 


117 


7.88 


0.0001 


1 868 


548 


1.59 


0.1130 


1 5 


379 


0.01 


0.9885 


1 246 


38 


6.47 


0.0001 


1 344 


269 


1.28 


0.2018 


1 1,715 


56 


30.70 


0.0001 


1 1,312 


177 


7.40 


0.0001 


1 -5 


102 


-0.05 


0.9593 


1 -121 


36 


-3.38 


0.0007 


1 -128 


40 


-3.18 


0.0015 


1 -207 


27 


-7.55 


0.0001 


1 70 


209 


0.33 


0.7397 


1 411 


153 


2.70 


0.0070 


1 1,189 


81 


14.63 


0.0001 


1 769 


98 


7.88 


0.0001 


1 -95 


136 


-0.70 


0.4851 


1 -62 


268 


-0.23 


0.8179 


1 330 


91 


3.63 


0.0003 


1 48 


70 


0.69 


0.4921 


1 -265 


42 


-6.34 


0.0001 


1 -221 


39 


-5.61 


0.0001 


1 165 


24 


6.84 


0.0001 


1 2,717 


132 


20.52 


0.0001 


1 282 


54 


5.18 


0.0001 


1 1.295 


66 


19.66 


0.0001 


1 931 


35 


26.66 


0.0001 


1 -60 


138 


-0.44 


0.6624 


1 -425 


46 


-9.31 


0.0001 


1 514 


44 


11.62 


0.0001 


1 380 


27 


14.02 


0.0001 


1 31 


47 


0.66 


0.5115 


1 1,813 


77 


23.65 


0.0001 


1 235 


78 


3.01 


0.0026 


1 -292 


49 


-5.91 


0.0001 


1 120 


30 


3.97 


0.0001 


1 646 


99 


6.52 


0.0001 


1 1,715 


290 


5.91 


0.0001 


1 1,560 


192 


8.13 


0.0001 


1 -695 


258 


-2.70 


0.0070 



dcg\fina^Tableh-2\nab 



TABLE H-2 (continued) 

REGRESSION OF 1992 MEDICARE PROGRAM EXPENDITURES ON 1992 HOSPITAL AND PHYSICIAN 
(ALL) DIAGNOSIS DIAGNOSTIC GROUPS 







PARAMETER 


STANDARD 


T FOR HO: 


VARIABLE 


ADDXG 


VARIABLE DF ESTIMATE 


ERROR 


PARAMETER=0 


PROB > ITl 


128.01 


pelvic fracture 


1 1,415 


145 


9.79 


0.0001 


129.01 


femoral fracture 


1 3,899 


73 


53.49 


0.0001 


130.01 


fractures of lower limb 


1 288 


80 


3.59 


0.0003 


131.01 


shoulder dislocation 


1 539 


239 


2.26 


0.0241 


131.02 


dislocation of hip 


1 3,526 


341 


10.34 


0.0001 


131.03 


dislocation of knee 


1 797 


140 


5.71 


0.0001 


131.04 


other dislocations 


1 -22 


-57^ 


-0.40 


0.6909 


131.05 


fracture of rib, closed 


1 -257 


104 


-2.46 


0.0138 


131.06 


handMrist/lower arm fracture 


1 226 


82 


2.75 


0.0059 


131.07 


other fractures 


1 470 


77 


6.10 


0.0001 


132.01 


foreign body in pharnyx/iarnyx 


1 821 


148 


5.55 


0.0001 


132.02 


heart/lung/blood vessels injury 


1 1,969 


■?r? 


8.88 


0.0001 


132.03 


gi/liver/kidney/spleen/pelvis 


1 1 ,806 


223 


8.09 


0.0001 


132.04 


open wound of eye 


133 


241 


0.55 


0.5816 


132.05 


open wound/injury of lower arm 


-482 


64 


-7.55 


0.0001 


132.06 


open wound of other sites 1 


232 


59 


3.91 


0.0001 


132.07 


amputation of limb/hand/foot/toe 1 


4,516 


200 


22.61 


0.0001 


132.08 


crushing injury 


-211 


292 


-0.72 


0.4698 


132.09 


foreign body in eye/ear/nose 1 


-80 


146 


-0.55 


0.5841 


133.01 


sprains 1 


-126 


39 


-3.21 


0.0013 


134.01 


concussion 1 


-153 


207 


-0.74 


0.4603 


134.02 


contusion/superficial injury 1 


-167 


36 


-4.70 


0.0001 


134.03 


accidental falls 1 


998 


75 


13.29 


0.0001 


134.04 


suicide/self-inflicted injury 1 


3,485 


447 


7.80 


0.0001 


134.05 


other accidents 1 


306 


86 


3.54 


0.0004 


135.01 


intracranial injury 1 


. 1,265 


105 


12.07 


0.0001 


136.01 


third degree burns 1 


5,766 


447 


12.89 


0.0001 


136.02 


other bums 


688 


165 


4.16 


0.0001 


136.03 


nerve injury 


1.053 


168 


6.28 


0.0001 


136.04 


early complications of trauma 1 


3,297 


205 


16.05 


0,0001 


137.01 


poison effects 


485 


111 


4.38 


0.0001 


137.02 


toxic effects, named substance 


308 


131 


2.35 


0,0186 


137.03 


toxic effects of other nonmedicinal 1 


-367 


171 


-2.15 


0.0316 


137.04 


allergy, unspecified 1 


-213 


102 


-2.09 


0.0371 


137.05 


adverse effects of drugs 1 


306 


65 


4.70 


0.0001 


138.01 


malfunction of internal orthop. dev. 


2,375 


179 


13.28 


0.0001 


138.02 


infection due to int. graft/device 1 


5.981 


174 


34.38 


0.0001 


138.03 


other complications of med. procedures 1 


4.246 


90 


47.18 


0.0001 


138.04 


other compl. of medical care 1 


6.013 


60 


100.32 


0.0001 


138.05 


misadventure to patient in surgery 1 


1,953 


206 


9.47 


0,0001 


139.01 


kidneyTheart/lung/liver transplant 1 


5.644 


317 


17.82 


0.0001 


139.02 


other organ transplant 1 


934 


239 


3.90 


0.0001 


139.03 


heartA^alve replacement 1 


2.057 


152 


13.50 


0,0001 


139.04 


joint replacement 1 


4.642 


98 


47.21 


0,0001 


139.05 


other organ replacement 1 


3.306 


353 


9.37 


0,0001 


139.06 


artificial opening status/attention 


4.136 


117 


35.44 


0.0001 


139.07 


postsurgical states, eye 


2,368 


414 


5.72 


0.0001 


139.08 


other postsurgical states 


2,585 


54 


48.07 


0,0001 


139.09 


machine dependence 1 


32,792 


418 


78.46 


0,0001 


140.01 


rehabilitation procedures 


5.348 


73 


72.77 


0.0001 


141.01 


radiotherapy 


2,385 


119 


19.96 


0,0001 


142.01 


chemotherapy 1 


2,634 


135 


19,46 


0,0001 


143.01 


infectious disease contact/carrier 1 


-41 


275 


-0.15 


0,8812 


143.02 


preventive 


-??9 


38 


-6.10 


0,0001 



8 

dcg\final\Tableh-2\nab 



TABLE H-2 (continued) 

REGRESSION OF 1992 MEDICARE PROGRAM EXPENDITURES ON 1992 HOSPITAL AND PHYSICIAN 
(ALL) DIAGNOSIS DIAGNOSTIC GROUPS 







PARAMETER 


STANDARD 


T FOR HO: 


VARIABLE 


ADDXG 


VARIABLE OF ESTIMATE 


ERROR 


PARAMETER=0 


PROB > 1T| 


143.03 


history of malignant neoplasm 


1 89 


54 


1.65 


0.0984 


143.04 


history of mental dis/oth disease 


1 392 


87 


4.49 


0.0001 


143.05 


history of dr^ig allergy 


1 701 


88 


7.95 


0.0001 


143.06 


family history of disease 


1 -266 


104 


-2.56 


0.0105 


143.07 


problems of int. organs/ext. sites 


1 697 


204 


3.42 


0.0006 


143.08 


elective surgery 


1 726 


397 


1.83 


0.0678 


143.09 


prothesis/other device fitting 


1 81 


160 


0.51 


0.6109 


143.10 


other orthopedic aftercare 


1 1.274 


148 


8.62 


0.0001 


143.11 


aftercare 


1 1,788 


91 


19.59 


0.0001 


143.12 


donor 


1 6,361 


387 


16.44 


0.0001 


143.13 


family/other pyschosocial circum. 


1 994 


309 


3.21 


0.0013 


143.14 


care not delivered 1 


1 1,166 


169 


6.92 


0.0001 


143.15 


administrative/consultation 1 


1 183 


123 


1.49 


0.1362 


143.16 


screening for malignant neoplasm 1 


-274 


46 


-5.93 


0.0001 


143.17 


screening/observation/special exam 1 
AGE/SEX 


253 


21 


12.20 


0.0001 




FEMALE. < 65 1 


-71 


55 


-1.30 


0.1923 




FEMALE. 70-74 1 


-55 


33 


-1.67 


0.0941 




FEMALE. 75-79 1 


-114 


35 


-3.21 


0.0013 




FEMALE. 80-84 1 


-237 


40 


-5.94 


0.0001 




FEMALE, 85 OR OLDER 1 


-514 


43 


-12.01 


0.0001 




MALE, < 65 1 


-232 


47 


-4.98 


0.0001 




MALE, 65-69 1 


-24 


38 


-0.62 


0.5334 




MALE, 70-74 1 


-73 


38 


-1.91 


0.0563 




MALE. 75-79 1 


-194 


42 


-4.59 


0.0001 




MALE. 80-84 1 


-430 


51 


-8.43 


0.0001 




MALE, 85 OR OLDER 1 


-552 


62 


-8.97 


0.0001 



SOURCE: 1992 Medicare claims 



dcg\finaMableh-2\nab 



TABLE H-3 

CONCURRENT HIERARCHICAL COEXISTING CONDITIONS (HCCs) 



HCC 



HOSPITAL AND PHYSICIAN DIAGNOSES 



Concurrent 
ADDCO' 



HCC 
Hierarchy 



Status for 
Models 



Hierarchy Rule 



Payment 



Classification 



Septicemla/Shock 

2.01 septicemia/shock 

Moderate Cost infectious Diseases 

3.01 HIV/AIDS (including pneumocytosis) 

4.07 bacterial infection in other diseases 



Other Infectious Disease 


1.01 


central nervous system infection (e.g.. meninflids) 


4.02 


viral enteritis Ontestinal infections) 


4.03 


other intestinal infections 


4.04 


tuberculosis 


4.05 


strep throat/scartet fever 


4.06 


other bacterial infections 


4.08 


herpes zoster (shingles) 


4.09 


herpes simplex 


4.10 


viral hepatitis 


411 


other viral infections 


4.12 


late syphilis, symptomatic 


4.13 


dermatophytosis (fungal skin infections, 




e.g.. athlete's foot) 


4.14 


thmsh 


4.15 


mycoses (fungal diseases), miscellaneous 


4.16 


other infections 


5.01 


infection late effects 



Metastatic Cancer 

19.01 secondary cancer of lymph node 

1 9.02 secondary cancer of respiratory and digestive 
systems 

19.03 secondary cancer of other site 

19.04 disseminated cancer 

High Cost Cancers 

7.01 cancer of esophagus 

7.02 cancer of stomach 

7.03 cancer of small bowel/peritoneum 

7.04 cancer of liver 

7.05 cancer of pancreas 

10.01 lung cancer 

12.04 myeloid leukemia 

17.02 cancer of the bcain/nervous system/pituitary, 
pineal glands 

Moderate Cost Cancers 

6.01 cancer of mouthftongue 

6.02 cancer of pharynx 

6.03 cancer of larynx 

6.04 other respiralory/intrathoracic cancer 
8.01 colon cancef 

9.01 rectal cancer 

12.01 lymph oma/Karposrs sarcoma/Hodgkin's Disease 

12.02 multiple myeloma 

12.03 lymphoid leukemia 

12.05 other leukemia 

14.01 cancer of ovaries/placenta/uterine adnexia 

15.02 cancer of testisMiale genital organs 

18.01 cancer of bone and articular cartilage 

18.02 cancer of connective and other soft tissue 

Lower Cost Cancers 

7.06 other, unspecified camber of digestive organs/ 
peritonium 

1 1 .01 breast cancer 

13.01 cancer of uterus 

13.02 cancer of cenrix/femal© genital organs 
15.01 prostate cancer 

16.01 cancer of bladder/kidney/urinary organs 
17.01 cancer of the eye 

18.03 melanoma 

18.05 thyroid/endocrine cancer 

18.06 other/ill-defined site cancer 

Carcinoma tn Situ 

21 .01 carcinoma in situ of digestive organs 

21 .02 carcinoma in situ of respiratory system 

21 .03 carcinoma in situ of other sites 

Uncertain Neoplasm 

21 .04 neoplasm of uncertain behavior, specified sites 

21 .05 neoplasm of uncertain t>ehavior nec/nos 

21.06 unspecified neoplasm 



20 



(8) 
02) 



(2) 



None 



None 



Out 



Out 



1 


P) 


14 


(20) 


20 




10 


(8) 


3 




2 


(5) 


5 


(8) 


3 


(5) 


5 


(12) 


14 


(12) 


3 


(8) 


10 


(12) 


3 


(8) 



Neoplasm 



Neoplasm 



If in HCC 4 cannot be in HCC 5. 



(3) 



(3) 
(2) 



(2) 
(") 

(2) 



Neoplasm 



If in HCC 4 or 5 cannot be in 
HCC 6 



Neoplasm 



If in HCC 4, 5, or 6, then cannot 
be in HCC 7. 



(?) 



4 (5) 

10 (8) 

3 (4) 



Neoplasm 



Neoplasm 



If in HCC 4-7, then 
cannot be in HCC 8. 



If in HCC 4 - 8, then cannot be 
in HCC 9. 



Out 



dcg\lira[\Tableh-3\dnib 



TABLE H^ 

CONCURRENT HIERARCHICAL COEXISTING CONDTTIONS (HCCs) 



MCC 

10 Skin Cancer, except Melanoma 

18.04 skin cancer, except melanoma, including tip 

11 Benign Neoplasm. Except Breast 

17.03 benign neoplasm bratn/nervous systenVpituitary, 
pineal glands 

20.01 t)enign neoplasm of digestive system 

20.02 t>enign neoplasm of respiratory system 

20.03 benign neoplasm of stun 

20.05 benign neoplasm of urinary tract 

20.06 benign neoplasm of ey© 

20.07 other tjenign neoplasms 

12 Benign Neoplasm of Breast/Ottier Breast Disorders 

20.04 benign neoplasm of breast/other breast disorders 

1 3 Dlat>etes Witfi Complications 

23.01 diabetes with acute complications 

24.01 diabetes with renal manifestation 

24.02 diabetes with other specified complications 

24.03 diabetes with unspecified complications 

25.01 hypoglycemic coma 

93.02 proliferative diabetic retinopathy 

14 Diabetes Without Complications 

22.01 diabetes without complications 
93.01 diathetic retinopathy 

15 Protein •Calorie Malnutrition 

27.09 protein-calorie malnutrition 

16 Other Higher Cost Endocrine, Metabolic, Nutritional 
Disorders 

26.01 disorders of flutd/electroiyte/acid-base balance 

27.04 adrenal gland disorders, e.g., Cushing's syndrome 

27.12 disorders of plasma protein metabolism 

17 Other Lower Cost Endocrine, Metabolic, Nutritional 
Disorders 

25.02 other hypoglycemia 

27.01 goiter 

27.02 thyrotoxicosis, including Graves' disease 

27.03 thyroid disorders 

27.05 ovarian dysfunction 

27.06 testicular dysfunction 

27.07 other endocrine disorder* 

27.08 pituitary/pa rath yroid/thymus/polyg la ndular disorders 

27.10 vitamin/other nutritional deficiencies 
{e.g., rickets, scurvey) 

27.13 disorders of mineral metabolism 

27.14 metabolism disoiders. nec/nos 

27. 1 5 other hyperalimentation 

27. 1 6 obesity/localized adiposity 

18 High Cholesterol 

27.11 disorders (^ flpoid metabolism (high cholesterd) 

19 Liver Disease 

29.01 end stage liver disorders 

29.02 esophageal varices 

20 Cirrhosis 

30.01 cirrhosis 

21 Peritonitis 

38.02 peritonitis 

22 High Cost Gastrointestinal Disorders 

4.01 bacterial enteritis (intestinal infections) 

28.01 acute pancreatitis 

33.01 pyloric/duodenal obstiuction 

38.01 intestinal obstruction 

38.03 other peritoneal disorders 

41 .02 biliary tract disease 

23 Moderate Cost Gastrointestinal Disorders 

32.02 ulcer with perforation 

34.01 appendicitis 

35.01 abdominal hernia, complicated 

40.03 intestinal abscess/ulceration/perforation 
41.01 cholelithiasis (gallstones) 

41 .03 other gallbladder disorders 



Concurre 


nt 


HOC 

HIerarchv 


HIerarchv Rule 


Status for 
Models 


ADDCO 


Pavment Classification 


1 




Neoplasm 


If in HCC 4 -9, then 
cannot be in HCC 10. 


Out Out 


3 


(1) 


Neoplasm 


If in HCC 4-10, then cannot 
tieinHCCII. 


Out Out 


1 
3 

1 
3 

1 
1 


(4) 









Neoplasm 



Diabetes 



If in HCC 4-1 1 , cannot be in 
HCC 12. 



Out 



(5) 
(2) 



Diabetes 



If in HCC 13, then cannot be 
in HCC 14. 



Out 



14 (20) 



None 



None 



Liver 



Out 



14 


(12) 






S 


(12) 










Liver 


If in HCC 19, cannot be in HCC 


1 
27 




Gastrointestinal 








Gastrointestinal 


If in HCC 21 then cannot be in 


5 


(8) 




HCC 22. 


5 


(8) 






8 








8 








8 


(12) 






8 


(12) 










Gastrointestinal 


If in HCC 21 or 22, cannot be in 


1 


(3) 




HCC 23. 


3 


(5) 






3 








3 








3 


(1) 






3 


W 







dcg\taMibleh-3\iim6 



TABLE H-3 

CONCURRENT HIERARCHICAL COEXISTING CONDmONS (HCCs) 



HCC 

24 Other Gastrointestinal Disorders 

28.02 chronic pancreatitis/other pancreatic disease/ 

intestinal malabsorption 

30.02 other liver disorders 

31 .01 disease of esophagus 

32.01 ulcer without perforation 

33.02 gastritis/other gastric disorder (stomach disorders) 
36.01 abdominal hemia/uncomplicated 

37.01 regional enteritis (Crohn's disease) 

37.02 ulcerative colitis 
39.01 divercula of intestine 

40.01 hemorrhoids 

40.02 anal/rectal disorders 
40.04 other intestinal disorders 
42.01 gastrointestinal hemontiage 

25 Bone and Joint Infections 

45.01 arthropathy v/itti infection 

45.02 osteomyelitis 

26 Rheumatoid Arthritis and Connective Tissue Disease 

44.01 systemic lupus erythematosus and other 
connective tissue disease 

44.02 rheumatoid arthritis and 

other tnflammatofy polyarthropathy 

27 Other Musculoskeletal and Connective Tissue Disorders 

43.01 gout/crystal arthropathy 

43.02 other arthropathy/joint disorders 

44.03 inflammatory spondylopathies 

44.04 polymyalgia rheumatica 
osteoarthrosis 
back disorders 

disorders of sctft tissue (e.g., tendonitis, bursitis) 
osteoporosis 

49.02 other bone disorders (e.g., curvature of spine. 
Pagefs disease) 

49.03 flat foot acquired deformities of toe 

49.04 other acquired limb deformities 
119.04 congenital anomalies of musculoskeletal/limb 



46.01 
47.01 
48.01 
49.01 



28 Aplastic Anemia 

51 .03 aplastic anemia 

29 Blood/Immune Disorders 

51.01 sickle cell and other hereditary hemolytic anemias 

51 .02 acquired hemolytic anemia 

51.04 hemophilia and other coagulation defects 

51.05 purpura/thrombocytopathy/hemorrhagic conditions 

51.06 white blood cell disorders 

51 .07 immune disorders 

30 Iron Deficiency and Other Anemias 

50.01 iron deficiency and other anemias 

51 .08 other blood disease 

31 Dementia 

52.01 senile/presenile psychoses 

52.02 other organic psychotic conditions 

52.03 cerebral degeneration/Alzheimer's disease 

52.04 senility without psychosis 

32 Drug/Alcohot Dependence/Psychoses 

53.01 alcoholic psychoses 

53.02 dnjg psychoses 

59.01 alcohol dependence 

59.02 dmg dependence 

33 Higher Cost Mental Disorders 

54.01 delirium/delusions/hallucinations 

54.02 hallucinations, s^ptomatic 
55.01 schizophrenic disorders 

56.01 manic and depressive disorders 

57.01 paranoid states 

57.02 other nonorganic psychoses 
60.01 personality disorders 
134.04 suicide/self-inflicted iniury 



Concurrent 
ADDCQ' 



6 

10 

4 

10 



10 
4 
3 
3 
4 
1 
8 

14 



HCC 

Hierarchy 

Gastrointestinal 



Status for 
Models 



Hierarchy Rule 

If in HCC 21 . 22, or 23. then cannot 
be in HCC 24. 



Payment 



Classification 



(3) 

(3) 



Musculoskeletal 



Musculoskeletal 



If in HCC 26 then cannot be 
in HCC 27. 



(3) 

(2) 



12 (10) 



Hematological 



Hematological 



(3) 



Hematological 



If in HCC 28 then cannot be 
in HCC 29. 



If in HCC 28 or 29 then cannot 
be in HCC 30. 



Out 



(12) 
(12) 



(8) 
(5) 



(3) 



Mental Disorders 



Mental Disorders 



If in HCC 32 then cannot 
be in HCC 33. 



dcg\fl^a^Tableh-3\dmb 



TABLE H-3 

CONCURRENT HIERARCHICAL COEXISTING CONDfTlONS (HCCs) 



HCC 

34 Lower Cost Mental DisordefS 

58.01 neurotic disorders 

59.03 non-dependent abuse of drugs 

60.02 sexual disorders 

60.03 psychophysiologic disorders 

60.04 acute reaction to stress 

60.05 adjustment reaction 

60.06 nonpsychotic brain syndrome 

60.07 other depression 
60.06 behavior disorder 

60.09 developmental/behavioral disorders 

60.10 mental retardation 

60. 1 1 other mental disordeis 

35 Quadrlplegla/Paraplegia 

63.03 quadriptegla 

63.04 paraplegia 

36 Higher Cost Neurological Disorders 

62.03 anterior horn cell disease, including Lou Gehrig's 
disease (ALS) 

62.04 other spinal cord disease 

62.05 autonomic ner/e disorder 

63.05 Cauda equina syndrome 

63.06 other paralytic disorders 

63.08 other central nervous system disorders 

66-02 inflammatoryAoxic neuropathy, including Guillain- 

Barre syndrome 
66.04 muscular dystrophies 
67.01 cerebral cysts, compression, edema, anoxic damage 

other brain conditions 
95 05 paralysis of vocal cords/larynx 

37 Other Costlier Neurological Disorders 

63.01 multiple sclerosis, other central nervous system 

dymelination 
64.01 epilepsy and other seizure disorders/convulsions 
66.03 myoneural disorders/myasthenia gravis 

38 Other Neurological Disorders 

62.01 Parkinson's disease 

62.02 Huntington's Disease, other abnormal movement 
disorders 

62.06 Other hereditary and degenerative 
central nervous system diseases 

63.02 infantile cerebral palsy 

65.01 thgemlnal nerve disorder 

65.02 facial nerve disorders, including Bell's Palsy 

65.03 root/plexus disordeis 

65.04 root/plexus lesions 

65.05 other cranial nen/e disorders 

65.06 neuropathy of upper (imb 

65.07 neuropathy of leg 
66.01 peripheral neuropathy 
66.05 other neuropathy 

11 9. 01 spinabiflda. other congenital anomalies 
of nen/ous system 

39 Respiratory Arrest 

105.02 respiratory anest 

40 Heart Arrest/ShocK 
79.01 heart arrest/shock 

41 Acute Myocardial Infarction (Heart Attack) 
72.01 acute myocardial infarction (heart attack) 

42 Other High-Cost Acute Heart Disease 
73.01 other acute ischemia 

78.01 ventric tachycardia 

81.01 pericarditis. post-MI 

81 .02 acute endo/myocarditis 

43 Congestive Heart Failure 

75.02 other pulmonary heart disease 
80.01 heart failure 

81.03 cardiomyopathy/myocanlitis 

44 Atrial Arrhythmia 

77.01 atrial arrhythmia 



Concurrent 
ADOCO' 



HCC 
Hierarchy 



Status for 
Models 



Hierarchy Rule 



Payment 



Classification 



Mental Disorders If in HCC 32 or 33, then cannot 
be in HCC 34. 



40 



17 



(12) 
(8) 



Nervous System 



Nervous System If in HCC 35. cannot be 
in HCC 36. 



3 


(8) 


3 


(4) 


2 


(4) 


3 


(8) 


4 


(5) 


3 




1 


(2) 


4 


(8) 



(4) 



Nervous System If in HCC 35 or 36. then cannot 
be in HCC 37. 



Nervous System If in HCC 35. 36. or 37. then 
cannot be in HCC 38. 



Out 



Cardio-Respiratory 
Arrest 

Cardio-Respiratory If in HCC 39, then cannot be 
(8) Arrest in HCC 40. 



Out 



Out 



(8) 
(8) 



(2) 



Heart 



Heart 



If in HCC 41, cannot be in 
HCC 42 



If in HCC 41 or 42. then cannot 
be in HCC 43. 



If in 41 or 42 or 43. then cannot 
be in HCC 44. 



dcg\(inaMat)feh-3\(Jmt) 



TABLE H-3 

CONCURRENT HIERARCHICAL COEXISTING CONDmONS (HCCs) 



HCC 

45 Valvular Heart Disease 

68.01 rheumatic fever/heart disease 

68.02 mitral or aortic vaWe/endocardia disease 

68.03 mitral/aortic valve disorders 

46 Coronary Artery Disease 

71.01 myocardial infarction 

71.02 old myocardial infarction 

71 .03 other chronic ischemic heart disease 
74.01 angina pectoris 

47 Other Heart Disorders 

76.01 conduction disorders/cardiac dysrhythmias 

1 1 9.03 congenital anomalies of cardiac/circulatory systems 

48 Hypertensive Heart Disease 

69.02 hypertensive heart disease 

70.02 malignant hypertensive heart disease 

70.03 hypertensive heart and renal disease 
70.05 hypertension encephalopathy 

49 Heart Disease, Miscellaneous 
76.02 premature heart beats 

81 .04 cardiomegaly (enlarged heart) 

81 .05 other heart disease 

50 Hypertension {High Blood Pressure) 
69.01 essential hypertension 

70.01 malignant hypertension 
70.04 secondary hypertension 

51 Hemiplegia/Aphasia 

84.02 hemiplegia (paralysis of one side of body) 

64.03 aphasia (loss of language skills/com prehension) 

52 Cerebral Hemorrhage 

82.01 cerebral hemorrhage 

53 Cerebrovascular Disease 

5,02 cerebrovascular disease late effects 

83.01 precerebral arterial occlusion 

84.01 cerebrovascular accident (stroke) 

85.01 transient cerebral ischemia 



Concurrent 
ADDCG- 


HCC 
Hlerarehv 


Hierarchy Rule 




w 


Heart 


If in HCC 41 -44, then 
cannot be in HCC 45. 




(1) 


Heart 


If in HCC 41 - 44, then 
cannot be in HCC 46. 














Heart 


lfinHCC41-46, cannot be 
in HCC 47. 






Heart 


If in HCC 41-47, cannot be 
in HCC 48. 




w 


Heart 


If in HCC 41.48, cannot be 
in HCC 49. 






Heart 


If in HCC 41-49, cannot be 
in HCC 50. 


14 
14 




Cerebrovascular 




6 


(8) 


Cerebrovascular 


If in HCC 51. cannot be 
HCC 52. 


3 
3 

1 

1 


C3) 


Cerebrovascular 


If in HCC 51 or 52, cannot be 
in HCC 53. 



Status for 

Models 



Payment Classification 



Out 



Out 



Out 



Out 



Out 



54 Gangrene 
89.07 gangrene 

55 Higher Cost Vascular Disease 

87.01 aortic aneurysm 

87.02 other aneurysm 

88.01 arterial embolism and thromtx)S)S 
89.06 vascular insufficiency of intestines 

56 Other Vascular Disease 

86 01 atherosclerosis of major vessel 

86.02 atherosclerosis/general, ascvd 

89.01 specified peripheral vascular disease 

89.02 Raynaud's syndrome 

89.03 peripheral vascular disease 

89.04 other arterial disease 

69.05 disease of capillaries 

90.01 phlebitis and thrombophlebitis 

90.02 noninfectious lymphatic disorders 

90.03 hemorrhage nos 

90.04 compression of vein 

91 .01 hypotension (lov^ blood pressure) 

92.01 superficial phlebitis-leg 

92.02 varicose veins 

92.03 other circulatory disease/postphtebitic syndrome 

92.04 other specified circulatory disorders 

57 Severe Acute Lung Conditions 

75.01 pulmonary embolism 

103.01 pleurisy/pneumothorax 

104.03 acute lung edema nos 

104.04 post trauma/surgery pulmonary insufficiency 

105.01 respiratoryfailure 

56 High Cost Pneumonia 

99-01 gram-negative/staphyloccocus pneumonia 

102.02 aspiration pneumonia 



23 



3 

3 (8) 

5 (8) 

8 



Vascular 



Vascular 



tf in HCC 54. cannot be in 
HCC 55. 



If in HCC 54 or 55. cannot be 
in HCC 56. 



(3) 
(8) 



8 


(12) 


10 


(12) 


17 


(20) 


40 




6 


(8) 


23 


(20) 


23 


(27) 



Lung 



Lung 



dcg\finaI\Tableh-3\dmt) 



TABLE H^ 

CONCURRENT HIERARCHICAL CODaSTlNG CONDmONS (HCCs) 



HCC 

59 Moderate Cost Pneumonia 

1CX).01 pneumoccxxal and other specific bacterial pneumoni 

104.01 empye ma/abscess 

€0 Other and Unspecified Pneumonia 
98.01 viral pneumonia 

100.02 other and unspecified pneumonia 

61 Chronic Lung Disease 

96.01 emphysema/chronic bronchitis 
101.01 asthma 

102.01 bronchiectasis/Iung disease due to specified external 
agents (e.g., black lung disease) 

102.03 respiratory condibons due to other and unspecified 
external agents/post inRammatory fibrosis 

62 Other Lung Disease 

97.01 other bronchitis 

98.02 influenza 

104.02 pulmonary congestJon/hypostasis 
104.05 other lung disease 

63 High Cost Eye Disorders 

93.03 endophthalmitis (eye inflammation] 

93.08 vitreous hemorrtiage 

64 Other Eye Disorders 

93.04 retinal disorders 

93.05 glaucoma 

93.06 cataract/lens replacement 

93.09 other eye disorders 

1 1 9.02 congenital anomalies of eye 

65 Ear, Nose, Mouth, and Throat Disorders 

94.03 vertiginous syndromes 

(e.g.. vertigo, i^njere's disease) 

94.04 hearing loss 

94.05 other ear disorders 

95.02 nasal polyps/allergic rhinitis (e.g., hay feveO 

95.03 chronic sinusitis 

95.04 larynx/vocal cord diseases 

95.06 disorders of teeth, gum. and jaw 
(eg. periodontitis, gingivitis) 

95.07 other diseases of upper respiratory system 
95.03 salivary gland diseases 

95.09 other oral soft tissue/tongue/jaw disorders 

66 Low Cost Eye, Ear, Nose, and Throat Disorders 
93.07 disorders of refraction and accommodation 

(e.g.. far-, near-sightedness, astigmatism) 

94.01 impacted ean^vax 

94.02 otitis media (middle ear infection) 

95.01 acute nose/throat infection (e.g., common cold) 

67 Acute Renal Failure 

106.02 acute renal failure 

68 Other Renal Failure 

106.01 nephritis, dialysis encounter 

106.03 chronic renal failure 

106.04 renal failure, unspecified 

69 Other Urinary System Disorders 

106.05 impaired renal function 
107.01 kidney infection 

1 08.01 renal/ureteral/bladder calculus 

109.01 urethral stricture 

109.02 hydronephros is/other renal/ureUiral disorders 
1 1 0.01 other urinary tract infections 

111.01 other urinary disorders 

70 Genital Disorders 

112.01 hyperplasia of prostate 

112.02 other prostatic disorders 

1 1 2.03 penis/testis/male genital organs disorders 

1 1 3.01 diseases of female pelvic organs 

1 1 3.02 vaginal and cervical diseases 

113.03 other diseases of female genital organs 

113.04 female stress incontinence 

113.05 menopausal and postmenopausal disorders 
114.01 genital prolapse 



^ncurrent 
ADDCO- 


HCC 

HIerarchv 


HIerarchv Rule 


6 (8) 
3 


Lung 


If in HCC 58, then cannot b( 
in HCC 59. 


3 
1 


Lung 


If in HCC 58 or 59, cannot b 
in HCC 60. 


1 

1 
1 


Lung 





Status for 
Models 



Payment 



Out 



Classification 



P) 



(2) 



V 



3 

3 (5) 

3 (1) 



Lung 



If in HCC 57.61, cannot be 
in HCC 62. 



Out 



Eye, Ear, Nose, and 
(3) Throat 



Eye. Ear, Nose, and 
Throat 



Eye, Ear. Nose, and 
Throat 



If in HCC 63, cannot be 
in HCC 64. 



Out 



Out 



Out 



Eye, Ear, Nose, and 
Throat 



Urinary 



If in HCC 63 - 65. cannot be 
in HCC 66. 



Out 



Urinary 



Urinary 



If in HCC 67. then cannot be 
in HCC 68. 



If in HCC 67 or 68. cannot be 
in HCC 69. 



Out 



P) 



(2) 



clcg'.final\Tableh-3\dmb 



TABLE H-3 

CONCURRENT HIERARCHICAL COEXISTING CONOmONS (HCCs) 



HCC 



71 



72 



73 



74 



7S 



Pregnancy/Perinatal Conditions 

115.01 pregnancy/birth complications, mother/child 

1 15.02 pregnancy with abortive outcome 

115.03 nomial pregnancy/delivery 

Chronic Ulcer of Skin 

1 1 7.01 chronic ulcer of skin 

Other Oermato logical Disorders 

1 1 6.01 cellulttjs/abscess/other focal skin infection 

1 1 6.02 bullous dermatoses 

1 1 8.01 dermatitis due to substances taken intemally 
(e.g., food, drugs) 

1 1 8.02 psoriasis and similar disorders 

118.03 other dermatosis 

1 18.04 diseases of nail (e.g., ingrown toenaiQ 

1 1 8.05 other dermatologicat disorders 
1 1 9.05 congenital anomalies of skin 

Vertebral Fractures 

1 26.01 vertebral fracture without spinal cord injury 

126.02 vertebral fracture with spinal cord injury 



Concurrent 
ADDCQ* 



Hip Fracture/Dislocation 

128.01 pelvic fracture 

1 29.01 femoral fracture 

131.02 dislocation of hip 

76 Higher Cost Injuries and Poisonings 

127.01 fractures of skull/face 

1 31 .03 dislocation of knee, including cartilage/meniscus tear 

132.02 injury to heart/I ung/intrathoracic organs/blood 
vessels of thorax 

132.03 gastrointestinat/ltver/kidney/spieenypelvis injury 
132.07 traumatic amputation of limb/hand/footAoe 
135.01 intracranial injury 

136.01 third degree burns 

136.04 early complications of trauma 

137.01 accidental poisoning by prescription or over-the- 
counter medications/biological substances, 
including medication errors 

77 Lower Cost Injuries and Poisonings 
5.03 injury late effects 

1 27.02 fractures of nasal bone 
130.01 fractures of lower limb 
131 .01 shoulder dislocation 

1 31 .04 other dislocations 

131.05 fracture of rib, ctosed 

1 31 .06 hand/wrist/lower arm fracture 

131.07 other fractures 

132-01 foreign body in pharynx/larynx 

132.04 open wound of eye 

1 32.05 open wound/injury of lower arm 

132.06 open wound of other sites 

132.08 crushing injury 

132.09 foreign body in eye/ear/nose 
133.01 sprains 

134.01 concussion 

134.02 contusion/superficial injury 

134.03 accidental falls 
134.05 other accidents 

136.02 other burns 

136.03 nefi^e injury 

137.02 toxic effects, named substance 

137.03 toxic effects of other nonmedicinal substances 

137.04 allergy, unspecified 

137.05 adverseeffectsof correctly prescribed and 
administered dnjgs in therapeutic use 

78 Complications of Medical and Surgical Care 

138.01 malfunction of interna! orthopedic device/graft 

138.02 infection/inflammation due to internal device/graft, 
transplant failure/rejection 

1 38.03 other complications of certain specified 
medical procedures 

1 38.04 other complications of medical and 

surgical procedures, nee (e.g., post-operative infection) 

1 38.05 misadventure or abnonnal reaction/complication 
of patient during surgery or medical care 



4 
27 

14 

14 
17 



(2) 



HCC 

Hierarchy 

None 



Skin 



Skin 



Status for 

Models 



Hierarchy Rule 



Payment 



Out 



Classification 



1 




1 




1 




1 


(0) 





(1) 


1 




1 




1 




3 




3 


(5) 


8 


(4) 


8 


(12) 


17 




3 


(2) 


2 




3 


W 


3 


(t) 


4 


(5) 


3 


(1) 


5 




1 


(3) 


3 





If in HCC 72, cannot be 
HCC 73. 



Out 



Out 



Injury 



Injury 



Injury 



Injury 



w 



(2) 



If in HCC 74-76. cannot be in 
HCC 77. 



Out 



(0) 



P) 



None 



dcg\finaMabtefv3\dfTib 



TABLE H-3 

CONCURRENT HIERARCHICAL COEXISTING CONDITIONS (HCCs) 



HCC 



79 Coma 

121.01 coma 



Concurrent 
ADDCQ' 



HCC 

Hierarchy 



Status for 
Models 



Hierarchy Rule 



Payment 



Classification 



80 Major Symptoms 

63.07 nervous/musculoskeletat system symptoms 1 

1 21 .02 syncope (fainting) and collapse 3 

122.01 fever 3 

123.01 dyspnea (labored breath ing}/other respiratory 1 
abnormalities 

123.02 hemoptysis (coughing up blood) 1 
123.04 respiratory/other chest symptoms 1 
124.01 chest pain 1 

125.01 retention of urine 5 

125.02 incontinence/urethfal discharge 1 
125.04 abdominal/pelvis symptoms 1 

61 Minor Symptoms, Signs, Findings 

61.01 headaches 1 

119.06 chromosomal anomalies 

119.07 other congenital anomalies 1 

120.01 somatic/seg mental dysfunction 1 

120.02 dizziness and giddiness 1 

120.03 malaise and fatigue 1 

120.04 other general symptoms 1 
123.03 cough 1 

1 24.02 other cardiovascular symptoms 1 

125.03 oUier urinary system symptoms 1 
143.01 infectious disease contact/carrier 
143.07 problems of internal organs/external sites 2 

143.13 household/family/other psychosocial circumstances 3 

143.14 care not delivered 3 



Out 



None 



Out 



Out 



PROCEDURES. AND FACTORS INFLUENCING CONTACT WITH HEALTH SERVICES 



82 



Heart. Lung. Kidney, Liver Transplant 

P9 heart, lung, kidney, liver transplant 



63 Heart Heart Vaive, Kidney, Lung. Uver Transplant (status/history) 

139.01 kidney, heart, heart valve (human/animal tissue], 3 
lung, liver transplant 

84 Other Organ Transplant/Replacement 

139.02 other organ transplant 

139.03 heart, heart valve replacement by artificial device 

139.04 joint replacement 

139.05 other organ replacement 

85 Tracheostomy 
P5 tracheostomy 

86 Gastrostomy 
P3 gastrostomy 

87 Enterostomy 
P4 enterostomy 

88 Artificial Opening Status/Attention 

139.06 artificial opening status/attention 

89 Machine Dependence 
139.09 aspirator, respirator, other machine dependence 
PI intubation/mechanical ventilation 



Transplant 
Transplant 

None 



If in HCC 82. then cannot be in 
in HCC 83. 



Out 



Out 



3 
8 
3 


Artificial Opening, 
Tracheostomy 

Artificial Opening 
Artificial Opening 




6 


Artificial Opening 


If in HCC 85-87, then cannot be 
in HCC 88. 




Tracheostomy 


If in HCC 85, then cannot be 



Post-Surgical States/Aftercare/Rehabilitation Procedures 

139.07 postsurgical states, eye 

139.08 other postsurgical states, including dialysis status 
140.01 rehabilitation procedures 

143.08 elective surgery 

1 43.09 prosthesis/other device fitting, adjustment 

143.10 other orthopedic aftercare 

143.11 aftercare 

143.12 donor 

Chemotherapy 

1 42.01 chemotherapy 
P8 chemotherapy 

Radiation Therapy 

141.01 radiation therapy 
P10 radiation oncology 



Out 



Out 



3 
14 
3 
3 
3 
1 
14 






4 


Chemo-ZRadio- 
Therapy 




6 


Chemo-ZRadio- 
Therapy 


If in HCC 91, then cannot be in 
in HCC 92. 



Out 



dcg\tinaf\Tat3lef>-3\dmb 



TABLE H^ 

CONCURRENT HIERARCHICAL COEXISTING CONDmONS (HCCs) 



HOC 

93 Venous Access Port 

P7 venous access port 

94 Dialysis 

P2 dialysis 

95 Surgical Amputations 

P6 surgical amputations 

96 Preventive/ScreeningfObservation^pecia! Exams 

1 43.02 vaccination, medical exam, other preventive 

1 43.1 5 administrative/consultation 

143.16 screening for malignant neoplasm 

143.17 screening/ot>sefvation/speciaI exams 

97 History of Disease 

1 43.03 history of malignant neoplasm 

1 43.04 history of mental disorder/other disease 

1 43.05 history of drug allergy/other health hazard 

143.06 family history of disease 

PRINCIPAL HOSPITAL INPATIENT DIAGNOSTIC GROUPS 



Concurrent 
ADDCQ' 



HCC 
Hierarchy 

None 



None 



Hierarchy Rule 



Status for 
Models 



Payment 



Classification 



None 



Out 



Out 



Out 



98 Highest Incremental Cost Principal Inpatient Diagnoses 

2 fi/loderate Cost Infectious Diseases 

4 Metastatic Cancer 

5 High Cost Cancers 

19 Uver Disease 

35 Quadriplegia/Paraplegia 

41 Acute Myocardial Infarction (Heart Attack) 

45 Valvular Heart Disease 

51 Hemiplegla/Aphasra 

52 Cerebral Hemorrhage 

55 Higher Cost Vascular Disease 
72 Chronic Ulcer otf Skin 

99 High Incremental Cost Principal Inpatient Diagnoses 

6 Moderate Cost Cancers 

9 Uncertain Neoplasm 

20 Cinhosts 

25 Bone and Joint infections 

26 Rheumatoid Arthritis and Connective Tissue Disease 

27 Other Musculoskeletal and Connective Tissue Disorders 
29 Blood/Immune Disorders 

33 Higher Cost Mental Disorders 

40 Heart Arrest/Shock 

42 Other High-Cost Acute Heart Disease 

46 Coronary Artery Disease 
54 Gangrene 

57 Severe Acute Lung Conditions 

75 Hip Fracture/Dislocation 

100 Moderate Incremental Cost Principal Inpatient Diagnoses 

3 Other Infectious Disease 

7 Lower Cost Cancers 

8 Carcinoma in Situ 

10 Skin Cancer, except Melanoma 

11 Benign Neoplasm. Except Breast 

12 Benign Neoplasm of Breast/Other Breast Disorders 

13 Diabetes With Complications 

1 4 Diabetes Without Complications 

21 Peritonitis 

22 High Cost Gastrointestinal Disorders 

23 Moderate Cost Gastrointestinal Disorders 

28 Aplastic Anemia 

31 Dementia 

32 Drug/Alcohol Dependence/Psychoses 

36 Higher Cost Neurological Disorders 
38 Other Neurotogtcal Disorders 

43 Congestive Heart Failure 

47 Other Heart Disorders 

53 Cerebrovascular Disease 

56 Other Vascular Disease 

58 High Cost Pneumonia 
61 Chronic Lung Disease 
68 Other Renal Failure 

76 Higher Cost Injuries and Poisonings 

78 Complications of Medical and Surgical Care 

91 Chemotherapy 

92 Radiation Therapy 



dcg\f!raI\Tabieh-3\dmb 



TABLE H-3 

CONCURRENT HIERARCHICAL COEXlSmNG CONDmONS (HCCs) 



HOC 



Concurrent 
ADDCO' 



HOC 

Hierarchy 



Hierarchy Rule 



Status for 

Models 



Payment 



Classification 



101 Lower Incremental Cost Principal Inpatient Diagnoses 
1 Septicemia/Shock 

18 Other Higher Cost Endocrine. Metabolic. Nutritional Disorders 

17 Other Lower Cost Endocrine, Metabolic, Nutritional Disorders 
24 Other Gastrointestinal Disorders 

30 Iron Deficiency and Other Anemias 

34 Lower Cost Mental Disoidets 

37 Other Costlier Neurological Disorders 

39 Respiratory Anest 

44 Atrial Arrtiythmia 

48 Hypertensive Heart Disease 

50 Hypertension (High Blood Pressure) 

59 Moderate Cost Pneumonia 

60 Other and Unspec^ied Pneumonia 

62 Other Lung Disease 

63 High Cost Eye Disorders 

64 Other Eye Disorders 

69 Other Urinary System Disorders 

70 Genital Disorders 

73 Other Dermatological Disorders 

74 Vertebral Fractures 

77 Lower Cost Injuries and Poisonings 

79 Coma 

88 Artificial Opening Status/Attent'on 

1 02 Lowest Incremental Cost Principal Inpatient Diagnoses 

49 Heart Disease, Miscellaneous 

65 Ear, Nose, Mouth, and Throat Disorders 

66 Low Cost Eye, Ear, Nose, and Throat Disorders 

67 Acute Renal Failure 

71 Pregnancy/Perinatal Conditions 

103 Other Principal Inpatient Diagnoses 
15 Protein-Calorie Malnutrition 

18 High Cholesterol 

80 Major Symptoms 

81 Minor Symptoms, Signs, Findings 

83 Heart, Heart Valve, Kidney, Lung, Liver Transplant (status/history) 

64 Other Organ Transplant/Replacement 

89 Machine Dependence 

90 Post-Surgical States/Aftercare/Rehabilitation Procedures 

96 Preventive/Screening/Obsen/ation/Special Exams 

97 History of Disease 

OTHER RISK FACTORS 



Out 



104 AgeySex 



Female: Younger than 65 
Female: 65-69 
Female: 70-74 
Female: 75-79 
Female: 80-84 
Female: 85 or older 
Male: Younger than 65 
Male: 65-69 
Male: 70-74 
Male: 75-79 
Male: 80-84 
Male: 85 or older 



* Nuinbers in parentheses sidicate DCGs assigned exdudvig tymptom, V-<o<le, and compicatians of medcal/surgical care DXG«. 
These DCGs are sliown only where different. 



SOURCE: 1992 (Diagnoses) and 1992 (Eqxndtins) Medicare claims. 



10 
dcglfinal\Tablefv3\dmb 



TABLE H-4 

HIERARCHICAL COEXISTING CONDITIONS CONCURRENT MODEL PARAMETER ESTIMATES 



HCCP-C MODEL 
(R'=.5250) 



HCC 


DESCRIPTIVE LABEL 


— 


INTERCEPT 


1 


Septicemia/Shock 


2 


Moderate Cost Infectious Diseases 


3 


Other Infectious Disease 


4 


Metastatic Cancer 


5 


High Cost Cancers 


6 


Moderate Cost Cancers 


7 


Lower Cost Cancers 


8 


Carcinoma In Situ 


9 


Uncertain Neoplasm 


10 


Skin Cancer, except Melanoma 


11 


Benign Neoplasm, Except Breast 


12 


Benign Neoplasm of Breast/Other 




Breast Disorders 


13 


Diabetes With Complications 


14 


Diabetes Without Complications 


15 


Protein-Calorie Malnutrition 


16 


Other Higher Cost Endocrine, Metabolic, 




Nutritional Disorders 


17 


Other Lower Cost Endocrine, Metabolic, 




Nutritional Disorders 


18 


High Cholesterol 


19 


Liver Disease 


20 


Cirrhosis 


21 


Peritonitis 


22 


High Cost Gastrointestinal Disorders 


23 


Moderate Cost Gastrointestinal Disorders 


24 


Other Gastrointestinal Disorders 


25 


Bone and Joint Infections 



COEFF. 

-319 

6,622 

3,447 

52 

5,175 

2,541 

713 

212 

97 

194 

-104 

73 

-336 

1.634 
106 

5,068 
2,884 

202 



STD. ERR. 

29 * 
80 * 
71 * 
27 
75* 
83 * 
60 • 
42* 

173 
50* 
61 
44 

36 * 

46 * 

30 * 
97* 

37 • 

30 • 



HCCP PAYMENT MODEL 


HCC-C 


MODEL 


(R^ = 


.4782) 




(R^=. 


.4704) 


COEFF. 


STD. ERR. 


COEFF. 


STD. ERR. 


193 




26* 


-278 


30 * 


8,087 




84* 


7,597 


85* 


4,939 




74* 


3,568 


75* 


— 




— 


-17 


29 


5,971 




77* 


8,109 


73 * 


3,174 




86* 


3,491 


87 * 


1,352 




62* 


1,621 


62 * 


741 




42* 


855 


43* 


— 




~ 


154 


183 


— 




_ 


235 


53* 


— 




— 


73 


64 


— 




— 


125 


46* 


- 




- 


-264 


38* 


2,068 




48* 


1,670 


48 * 


— 




— 


83 


31 * 


6,393 




101 * 


7,052 


100* 


— 


' 


— 


2,892 


39* 



216 



31 



-312 


26 * 


- 


- 


-345 


28 


4,723 


194* 


5,603 


203 * 


5,374 


205 


669 


166 * 


1,212 


174 * 


427 


176 


9,119 


221 * 


11,586 


231 * 


12,465 


232 


3,514 


57 * 


5,200 


58* 


3,840 


60 


1,444 


60* 


2,415 


61 * 


1,497 


63 


203 


23 * 


~ 


— 


241 


24 


2,473 


109* 


3,459 


113* 


2,973 


114 



1 

dcg\rinal\TabIeh-4\nab 



TABLE H-4 

HIERARCHICAL COEXISTING CONDITIONS CONCURRENT MODEL PARAMETER ESTIMATES 



HCC 


DESCRIPTIVE LABEL 


26 


Rheumatoid Arthritis and Connective 




Tissue Disease 


27 


Other Musculoskeletal and Connective 




Tissue Disorders 


28 


Aplastic Anemia 


29 


Blood/Immune Disorders 


30 


Iron Deficiency and Other Anemias 


31 


Dementia 


32 


Drug/Alcohol Dependence/Psychoses 


33 


Higher Cost Mental Disorders 


34 


Lower Cost Mental Disorders 


35 


Quadriplegia/Paraplegia 


36 


Higher Cost Neurological Disorders 


37 


Other Costlier Neurological Disorders 


38 


Other Neurological Disorders 


39 


Respiratory Arrest 


40 


Heart Arrest/Shock 


41 


Acute Myocardial Infarction (Heart Attack) 


42 


Other High-Cost Acute Heart Disease 


43 


Congestive Heart Failure 


44 


Atrial Arrhythmia 


45 


Valvular Heart Disease 


46 


Coronary Artery Disease 


47 


Other Heart Disorders 


48 


Hypertensive Heart Disease 


49 


Heart Disease, Miscellaneous 


50 


Hypertension (High Blood Pressure) 


51 


Hemiplegia/Aphasia 


52 


Cerebral Hemorrhage 



HCCP-C MODEL 


HCCP PAYMENT MODEL 


HCC-C MODEL 


(R^« 


.5250) 


(R^ = 


.4782) 


(R^ 


=.4704) 


COEFF. 


STD. ERR. 


COEFF. 


STD. ERR. 


COEFF. 


STD. ERR. 


396 


55* 


1,008 


56 * 


462 


58* 


-30 


20 


- 


- 


83 


21 * 


5,654 


161 • 


6,019 


168* 


6,674 


169* 


2,050 


59* 


2,720 


62* 


2,575 


63* 


1,331 


32* 


— 


— 


1,443 


34* 


254 


46* 


— 


— 


70 


49 


3,833 


101 * 


4,567 


105* 


3,883 


106 * 


1,936 


43 * 


2,472 


43* 


1,873 


45 * 


175 


36 * 


~ 


— 


126 


38 * 


5,206 


188 • 


6,552 


197* 


6,254 


199 * 


2,455 


58* 


3,270 


60* 


3,070 


61 * 


761 


60* 


1,149 


62* 


748 


63* 


331 


43* 


— 


— 


391 


45* 


9,639 


136 * 


— 


— 


16,639 


139* 


4,336 


105 * 


- 


- 


5,399 


110 * 


9,004 


85* 


11,926 


86 * 


9,645 


89 * 


4,756 


52* 


6,857 


51 * 


5,327 


55 * 


1,227 


35 * 


2,340 


34* 


1,424 


37* 


583 


54* 


1,348 


55* 


842 


57* 


403 


60 * 


1,155 


62* 


588 


63 * 


-49 


30 


~ 


~ 


133 


32 * 


104 


55 


— 


— 


232 


58* 


33 


67 


— 


— 


36 


70 


155 


79 


— 


— 


291 


84 * 


-46 


25 


— 


~ 


-26 


26 


6,414 


82 * 


7,818 


85* 


7,188 


86* 


3,130 


135 * 


3,876 


141 * 


3,486 


142* 

2 

dcg\final\Tableh-4\nab 



TABLE H-4 

HIERARCHICAL COEXISTING CONDITIONS CONCURRENT MODEL PARAMETER ESTIMATES 



HOC 


DESCRIPTIVE U\BEL 


53 


Cerebrovascular Disease 


54 


Gangrene 


55 


Higher Cost Vascular Disease 


56 


Other Vascular Disease 


57 


Severe Acute Lung Conditions 


58 


High Cost Pneumonia 


59 


Moderate Cost Pneumonia 


60 


Other and Unspecified Pneumonia 


61 


Chronic Lung Disease 


62 


Other Lung Disease 


63 


High Cost Eye Disorders 


64 


Other Eye Disorders 


65 


Ear, Nose, Mouth, and Throat Disorders 


66 


Low Cost Eye, Ear, Nose, and 




Throat Disorders 


67 


Acute Renal Failure 


68 


Other Renal Failure 


69 


Other Urinary System Disorders 


70 


Genital Disorders 


71 


Pregnancy/Perinatal Conditions 


72 


Chronic Ulcer of Skin 


73 


Other Dermatological Disorders 


74 


Vertebral Fractures 


75 


Hip Fracture/Dislocation 


76 


Higher Cost Injuries and Poisonings 


77 


Lower Cost Injuries and Poisonings 


78 


Complications of Medical and 




Surgical Care 


79 


Coma 



HCCP-C MODEL 


HCCP PAYMENT MODEL 


HCC-C MODEL 


(R=== 


.5260) 


{R^- 


.4782) 


(R^= 


.4704) 


COEFF. 


STD. ERR. 


COEFF. 


STD. ERR. 


COEFF. 


STD. ERR. 


911 


34 * 


1,526 


35 * 


971 


36* 


7,061 


152 * 


7,849 


159* 


10,223 


144* 


2,998 


64* 


3,931 


66* 


3,341 


68* 


575 


27* 


— 


— 


662 


28* 


4,344 


43* 


5,927 


44* 


5,263 


45* 


7,676 


99 * 


8,144 


103* 


9,277 


104 * 


2,690 


119 * 


2,990 


124* 


2,645 


126 * 


1,444 


43 * 


- 


— 


1,548 


46 * 


734 


27 * 


1,277 


28* 


727 


29 * 


262 


33 * 


— 


— 


295 


35 * 


511 


165* 


1,011 


172* 


543 


174 * 


-120 


19* 


— 


— 


-98 


20* 


-195 


26 * 


— 


— 


-135 


28* 


-403 


39 * 


- 


- 


-410 


41 * 


6,851 


126* 


8,356 


131 * 


10,172 


129 * 


1,655 


78* 


2,444 


81 * 


1,848 


82 * 


522 


26* 


— 


- 


504 


27* 


-13 


25 


— 


— 


26 


26 


1,303 


111 * 


- 


- 


1,437 


117* 


1,892 


55 * 


2,442 


57* 


1,914 


59* 


-87 


22 * 


— 


— 


-95 


23* 


1,193 


93 * 


1,730 


97* 


1,329 


98* 


4,342 


66* 


6,785 


67* 


5,176 


69* 


2,007 


57* 


2,914 


59* 


2,553 


60* 


90 


24 * 


~ 


— 


222 


25 * 


6,670 


50 * 


— 


— 


8,454 


52 * 



2,599 



132 



3,440 



139 



3,363 



140 



dcg\final\Tableh-4\nab 



TABLE H-4 

HIERARCHICAL COEXISTING CONDITIONS CONCURRENT MODEL PARAMETER ESTIMATES 



HCC DESCf=;iPTIVE LABEL 

80 Major Symptoms 

81 Minor Symptoms, Signs, Findings 

82 Heart, Lung, Kidney, Liver Transplant 

83 Heart, Heart Valve, Kidney, Lung, 
Liver Transplant (status/history) 

84 Other Organ Transplant/Replacement 

85 Tracheostomy 

86 Gastrostomy 

87 Enterostomy 

88 Artificial Opening Status/Attention 

89 Machine Dependence 

90 Post-Surgical States/Aftercare/ 
Rehabilitation Procedures 

91 Chemotherapy 

92 Radiation Therapy 

93 Venous Access Port 

94 Dialysis 

95 Surgical Amputations 

96 Preventive/Screening/Observation/ 
Special Exams 

97 History of Disease 

98 Highest Incremental Cost Principal Inpatient Diagnoses 

99 High Incremental Cost Principal Inpatient Diagnoses 

100 Moderate Incremental Cost Principal Inpatient Diagnoses 

101 Lower Incremental Cost Principal Inpatient Diagnoses 

102 Lowest Incremental Cost Principal Inpatient Diagnoses 

103 Other Principal Inpatient Diagnoses 



HCCP-C MODEL 
(R^=.5250) 



COEFF. 
691 
173 

120,188 
3,175 

4,507 
59,695 
5.194 
11,571 
3,510 
7,272 
3.833 

3,416 
-1,136 

7,008 

20,537 

12,541 

322 

431 



STD. ERR. 

22 * 

21 * 

1,946 * 

319* 

76 • 
307 • 
173 * 
332* 
130 * 

77 * 
40 * 

98* 
135* 
233 * 
345 * 
277* 

20 * 

40 * 



HCCP PAYMENT MODEL 
(R' = .4782) 



HCC-C MODEL 
(R^=.4704) 



COEFF. 



126,486 
6,884 



63,513 
7.303 

13,345 
5,284 
8,775 



3,843 

8,347 
22,274 
14,509 



STD. ERR. 



2,039 * 
333* 



315 
180 
348 
136 
76 



103 

244 
361 
290 



COEFF. 
798 
262 



STD. ERR. 
24 * 
22 * 



dcg\final\Tableh-4\nab 



TABLE H-4 

HIERARCHICAL COEXISTING CONDITIONS CONCURRENT MODEL PARAMETER ESTIMATES 



HCC DESCRIPTIVE LABEL 

AGE/SEX 
FEMALE, < 65 
FEMALE. 70-74 
FEMALE, 75-79 
FEMALE, 80-84 
FEMALE. 85 OR OLDER 
MALE, < 65 
MALE, 65-69 
MALE, 70-74 
MALE, 75-79 
MALE, 80-84 
MALE, 85 OR OLDER 



HCCP-C MODEL 


MGCP PAYMENT MODEL 


HCC-C MODEL 


(R^= 


.5250) 




(R^ = 


.4782) 




(R^= 


i.4704) 


COEFF, 


STD 


. ERR. 


COEFF. 


STD 


. ERR. 


COEFF. 


STD. ERR. 


142 




54* 


246 




56* 


155 


57 * 


-12 




33 


68 




35 


-51 


35 


-65 




35 


104 




37* 


-123 


37* 


-195 




40 * 


26 




41 


-335 


42* 


-580 




42* 


-372 




43* 


-857 


45* 


33 




46 


-114 




47* 


49 


48 


102 




37 * 


72 




38 


149 


39* 


61 




37 


98 




38* 


110 


39* 


-31 




41 


93 




42* 


-16 


43 


-260 




50* 


-117 




51 * 


-393 


53 * 


-454 




61 * 


-235 




63* 


-780 


64 * 



* indicates p <= .05 (coefficient is statistically significant) 

NOTE: Omitted age/sex category is female, 65-69. 

SOURCE: 1992 (Expenditures) and 1992 (Diagnoses) Medicare claims 



dcg\final\Tableh-4\nab 



APPENDIX I: 

SPECIALTY CODES CONSIDERED 
PHYSICIAN SPECIALTIES 



TABLE 1-1 

1991 SPECIALTY CODES CONSIDERED PHYSICIAN SPECIALTIES 



Specialty Code and Description 

01 Genera! Practice 

02 General Surgery 

03 Allergy/Immunology 

04 Otolaryngology 

05 Anesthesiology 

06 Cardiology 

07 Dermatology 

08 Family Practice 

09 Gynecology (Osteo) 

10 Gastroenterology 

11 intemal Medicine 

12 Osteo. Manipulative Therapy 

13 Neurology 

14 Neurosurgery 

15 Obstetrics (Osteo) 

16 Obstetrics/Gynecology 

17 Ear, Nose, Throat (Osteo) 

18 Ophthalmology 

19 Oral Surgery (Dentists only) 

20 Orthopedic Surgery 

21 Path. Anat., Clinical Pathology (Osteo) 

22 Pathology 

23 Peripheral Vascular Disease (Osteo) 

24 Plastic and Reconstructive Surgery 

25 Physical Medicine and Rehabilitation 

26 Psychiatry 

27 Psychiatry, Neurology (Osteo) 

28 Colorectal Surgery 

29 Pulmonary Disease 

30 Diagnostic Radiology 

31 Roentgenology, Radiology (Osteo) 

32 Radiation Therapy (Osteo) 

33 Thoracic Surgery 

34 Urology 



Specialty Code and Description 

35 Chiropractic 

36 Nuclear Medicine 

37 Pediatric Medicine 

38 Geriatric Medicine 

39 Nephrology _ 

40 Hand Surgery 

41 Optometrist 

44 Infectious Disease 

46 Endocrinology 

48 Podiatry 

66 Rheumatology 

70 Clinic/Other Grp Practice, except GPPP 

76 Peripheral Vascular Disease 

77 Vascular Surgery 

78 Cardiac Surgery 

79 Addiction Medicine 

81 Critical Care (Intensivists) 

82 Ophthalmology-Cataracts Specialty 

83 Hematology/Oncology 

84 Preventive Medicine 

85 Maxillofacial Surgery 

86 Neuropsychiatry 

90 Medical Oncology 

91 Surgical Oncology 

92 Radiation Oncology 

93 Emergency Medicine 

94 Interventional Radiology 

96 Unknown Physician Specialty 

99 Unknown Supplier/Provider 



SOURCE: May 1992 HCFABPO memo. 



dcg\final\Tat>-i1\nab 



TABLE H-1 I 

1992 MEDICARE PROGRAM EXPENDITURES AND 1992 FREQUENCY OF ENROLLEES FOR 
CONCURRENT PRINCIPAL INPATIENT DIAGNOSTIC GROUPS (UPPER CASE LABELS) 
AND HOSPITAL AND PHYSICIAN DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXO 



Label 



- ENTIRE 2.5% MODEL DEVELOPMENT SAMPLE 

-1 DIAG CODE NOT VALID 
-1 .0 diag code not valid 

NO INPATIENT CUIMS IN DATA 
0.0 no claims in any data 

INFECTIOUS AND PARASITIC DISEASES 







Standard 


Coefficient 




Mean 


Error 


of Variation 


Frequency* 


Expenditures" 

$3,783 


of Mean 


(X 100) 


680.188 


$13 


273 


10 


27,398 


6,522 


75 


5.032 


9,711 


260 


190 


35.521 


816 


3 


226 


71,102 


49 


3 


1,780 



1 CENTRAL NERVOUS SYSTEM INFECTION (E.G., MENINGITIS, ENCEPHALITIS) 
1.01 central nervous system infection (e.g , meningitis, encephalitis) 

2 SEPTICEMIA/SHOCK (BLOOD POISONING) 
2.01 septicemia/sfiock (blood poisoning) 

3 HlV/AlDS (INCLUDING PNEUMOCYTOSIS) 
3 01 HIV/AIDS (including pneumocytosis) 

A OTHER INFECTIOUS AND PARASITIC DISEASES 

4.01 bacterial enteritis (intestinal infections) 

4.02 viral enteritis (intestinal infections) 

4.03 other intestinal infections 

4.04 tuberculosis 

4.05 strep throat/scarlet fever 

4.06 other bacterial infections 

4.07 bacterial infection in other diseases 

4.08 herpes zoster (shingles) 

4.09 herpes simplex 

4.10 viral hepatitis 

4.11 other viral infections 

4.12 late syphilis, symptomatic 

4.13 dermatophytosis (fungal skin infections, e.g., athlete's foot) 

4.14 thnjsh ^ 

4.15 mycoses (fungal diseases), miscellaneous 

4.16 other infections 



121 


27,797 


2,394 


95 


1,872 


14,862 


554 


161 


3,464 


28,387 


478 


99 


11,212 


29,248 


345 


125 


47 


39,154 


6,299 


110 


500 


18,714 


1,542 


184 


1,584 


21,503 


697 


129 


1,531 


21,832 


789 


141 


2,290 


8,350 


317 


182 


2,488 


10,217 


385 


188 


2,118 


10,476 


430 


169 


1,189 


4,855 


292 


207 


1,104 


13,025 


696 


178 


11,359 


18,951 


203 


114 


7,288 


5,515 


129 


199 


2,097 


7,225 


321 


204 


769 


12,961 


768 


164 


13770 


5,220 


100 


225 


322 


11,721 


1,137 


174 


54,540 


6,688 


56 


195 


1,453 


16.548 


577 


133 


3,119 


13,923 


472 


189 


8,919 


9,833 


204 


196 



LATE EFFECTS 



5 LATE EFFECTS 

5 01 infection late effects 

5.02 cerebrovascular disease late effects 

5.03 injury late effects 



289 


30,182 


1,391 


78 


684 


11.953 


674 


148 


11,550 


14,816 


181 


131 


1,769 


13,931 


432 


130 



MALIGNANT NEOPLASM 



6 MOUTH/PHARYNX/LARYNX/OTHER RESPIRATORY CANCER 

6.01 cancer of mouth/tongue 

6.02 cancer of pharynx 

6.03 cancer of larynx 

6.04 other respiratory/intrathoracic cancer 

7 STOMACH/SMALL BOWELfl-IVER/PANCREAS/ESOPHAGUS CANCER 
7 01 cancer of esophagus 

7.02 cancer of stomach 

7.03 cancer of small boweiyperitoneum 

7.04 cancer of liver 

7.05 cancer of pancreas 

7 06 other cancer of digest'rve organs/peritoneum 

8 COLON CANCER 
8.01 colon cancer 

9 RECTAL CANCER 

9 01 rectal cancer 

10 LUNG CANCER 

10 01 lung cancer 



312 


29,466 


1,421 


85 


1.121 


13,201 


627 


159 


756 


16,799 


871 


143 


1,043 


12,889 


668 


167 


529 


15,517 


1,039 


154 


969 


33,487 


1,054 


98 


592 


22,572 


1,254 


135 


1,065 


21,119 


794 


123 


818 


22,008 


784 


102 


1,120 


22,024 


750 


114 


1,041 


21,665 


909 


135 


656 


16,469 


800 


124 


1,440 


24,496 


477 


74 


7,149 


13,001 


209 


136 


570 


24.585 


643 


62 


5,714 


13,318 


234 


133 


1,773 


29,930 


547 


77 


7,537 


18,023 


253 


122 



CcgVinafVTatleh-l^md 



TABLE H-1 

1992 MEDICARE PROGRAM EXPENDITURES AND 1992 FREQUENCY OF ENROLLEES FOR 
CONCURRENT PRINCIPAL INPATIENT DIAGNOSTIC GROUPS (UPPER CASE LABELS) 
AND HOSPITAL AND PHYSICIAN DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXG 



Label 



MALIGNANT NEOPLASM 



(continued) 



11 BREAST CANCER 
11.01 breast cancer 

12 HODGKIN"S DISEASE/LYMPHOMA/MYELOMA/LEUKEMIA 

12.01 lymphonia/Karposi's sarcoma/Hodgkin's Disease 

12.02 multiple myeloma 

12.03 lympfioid leukemia 

12.04 myeloid leukemia 

12 05 ottier leukemia 

1 3 CANCER OF UTERUS/CERVIX/FEMALE GENITAL ORGANS 

13 01 cancer of uterus 

13.02 cancer of cervix/female genital organs 

14 CANCER OF PLACENTA/OVARYAJTERINE ADNEXIA 
14.01 cancer of ovaries/placenta/utenne adnexia 

15 CANCER OF PROSTATE/TESTIS/MALE GENITAL ORGANS 
15 01 prostate cancer 

15 02 cancer of testis/male genital organs 

1 6 CANCER OF BLADDER/KIDNEY/URINARY ORGANS 

16 01 cancer of bladder/kidney/unnary organs 

17 NEOPLASM OF NERVOUS SYSTEM 

17.01 cancer of ttie eye 

17.02 cancer of ttie brain/nervous system/pituitary. pineal glands 

17 03 benign neoplasm brain/ner^'ous system/pituitarv. pineal glands 

18 OTHER CANCER 

18 01 cancer of bone and articular cartilage 

18.02 cancer of connective and other soft tissue 
18 03 melanoma 

18 04 skin cancer, except melanoma, including lip 

18 05 ttiyroid/endocrine cancer 

18 06 ottier/ill-defined site cancer 

19 SECONDARY CANCERS 

19 01 secondary cancer of lymph node 

19 02 secondary cancer of respiratory and digestive systems 

19.03 secondary cancer of other site 
19 04 disseminated cancer 







Standard 


Coefficient 




Mean 


Error 


of Variation 


Frequency' 


Expenditures" 


of Mean 


(x100) 


1,394 


11,180 


283 


95 


13,646 


5,881 


94 


187 


827 


35,017 


1,043 


86 


3,519 


12,796 


340 


158 


1,202 


13.907 


544 


136 


1.682 


11.195 


498 


182 


623 


21,110 


1,270 


150 


1,206 


16,711 


747 


155 


500 


16,856 


677 


90 


1,942 


8,611 


323 


165 


1,308 


9,776 


451 


167 


196 


29,452 


1,453 


69 


1.321 


15,364 


559 


132 


2.036 


14,494 


286 


89 


17,347 


7,844 


100 


168 


406 


11,429 


797 


141 


1,012 


20,226 


583 


92 


6,343 


9.949 


210 


168 


336 


31,969 


1,175 


67 


335 


6.417 


645 


184 


2,439 


16.789 


457 


135 


1,679 


11,408 


405 


145 


440 


21,296 


982 


97 


1.459 


16.828 


659 


150 


1,144 


13,369 


579 


146 


1,610 


7.113 


308 


173 


25,168 


4.740 


61 


205 


631 


10.923 


734 


169 


9,224 


14.788 


213 


138 


2,454 


31.965 


534 


83 


2,774 


22.043 


447 


107 


5,974 


24.121 


297 


95 


7,728 


20.137 


256 


112 


1,683 


18,876 


601 


131 



BENIGN NEOPLASM, CARCINOMA IN SITU 



20 BENIGN NEOPLASMS 

20 01 benign neoplasm of digestive system 

20.02 benign neoplasm of respiratory system 
20 03 benign neoplasm of skin 

20.04 tienign neoplasm of breast 

20 05 benign neoplasm of unnary 

20.06 tienign neoplasm of eye 

20.07 other benign neoplasms 

21 CARCINOMA IN SITU/NEOPLASM OF UNCERTAIN BEHAVIOR 
21 .01 carcinoma in situ of digestive organs 

21 02 carcinoma in situ of respiratory system 

21.03 carcinoma in situ of other sites, excluding skin 
21 04 neoplasm of uncertain behavior, specified sites 
21 05 necplasm of uncertain behavior nec/nos 
2106 unspecified neoplasm 



871 


13,827 


604 


129 


19.186 


7,494 


96 


178 


1.446 


16,119 


651 


154 


18,021 


3,709 


60 


215 


71.490 


3,150 


27 


225 


995 


11,054 


524 


150 


1,131 


3,964 


241 


205 


13,207 


7,077 


111 


181 


577 


21,625 


1.072 


119 


1,746 


16.989 


516 


127 


1,049 


19.571 


658 


109 


4,932 


10.119 


217 


150 


6,851 


12.209 


217 


147 


12,545 


6.278 


116 


207 


23,360 


10.702 


111 


159 



dcg^firaSTaKeh-nrr.a 



TABLE H-1 

1992 MEDICARE PROGRAM EXPENDITURES AND 1992 FREQUENCY OF ENROLLEES FOR 
CONCURRENT PRINCIPAL INPATIENT DIAGNOSTIC GROUPS (UPPER CASE LABELS) 
AND HOSPITAL AND PHYSICIAN DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DX6 



Label 



ENDOCRINE, NUTRITIONAL. AND METABOLIC DISEASES 

22 DIABETES WITHOUT COMPLICATIONS 
22.01 diabetes without complications 

23 DIABETES WITH ACUTE COMPLICATIONS 
23.01 diat)etes with acute complications 

24 DIABETES WITH CHRONIC COMPLICATIONS 

24.01 diabetes with renal manifestation 

24.02 diabetes with other specified complications 

24.03 diabetes with unspecified complications 

25 HYPOGLYCEMIA 

25.01 hypoglycemic coma 

25.02 other hypoglyr^-ia 

26 DISORDERS OF FLUID/ELECTROLYTBACID BASE BALANCE 
26.01 disorders of fluid/electrolyte/acid-base balance 

27 OTHER ENDOCRINE/NirrRITIONAUMETABOLIC DISEASES 

27.01 goiter 

27.02 thyrotoxicosis, including Graves' disease 

27.03 thyroid disorders 

27.04 adrenal gland disorders, e.g.. Cushing's syndrome 

27.05 ovarian dysfunction 

27.06 testicular dysfunction 

27.07 other endocrine disorders 

27.08 pituitary/parathyroid/thymus/polyglandular disorders 

27.09 protein-calone malnutrition 

27.10 vitamin/other nutritional deficiencies (e.g., PKU, rickets, scurvey) 

27.11 disorders of lipoid metabolism (high cholesterol) 

27.12 disorders of plasma protein metabolism 

27.13 disorders of mineral metalxjiism 

27.14 cystic fibrosis, porphyria, metabolism disorders, nec/nos 

27.15 other hyperalimentation 

27.16 obesity/localized adiposity 







Standard 


Coefficient 




Mean 


Error 


of Variation 


Frequency* 


Expenditures" 


of Mean 


(x 100) 


454 


28,619 


1,594 


119 


91,607 


6,857 


47 


207 


359 


17,785 


977 


104 


3,258 


13214 


349 


151 


2,239 


21,824 


492 


107 


1,779 


18,105 


577 


134 


11,385 


12,897 


186 


154 


16,976 


12,557 


148 


154 


534 


23,086 


1,194 


120 


706 


16,551 


825 


132 


4,323 


12.2-5 


291 


156 


4,536 


21,135 


303 


97 


54,428 


16,428 


93 


132 


853 


19,911 


650 


95 


4,114 


5,699 


185 


209 


5,890 


5,636 


144 


197 


39,609 


5,514 


58 


209 


1,640 


16,269 


648 


161 


1,752 


2,937 


165 


236 


485 


5,898 


542 


202 


2,934 


5,361 


203 


206 


2,647 


11,276 


373 


170 


7,511 


28,421 


389 


119 


5,622 


8,391 


210 


188 


95,053 


3,610 


28 


235 


1,797 


15233 


514 


143 


4,110 


12,681 


341 


173 


1,852 


7,935 


350 


190 


448 


8,155 


778 


202 


8,022 


7,512 


150 


178 



GASTROINTESTINAL DISORDERS 



28 PANCREATITIS/ OTHER PANCREATIC DISORDERS 

28.01 acute pancreatitis 

28.02 chronic pancreatitis/other pancreatic diseases/intestinal malabsorption 

29 END STAGE LIVER DISORDERS 

29.01 end stage Irver disorders 

29.02 esophageal varices 

30 OTHER LIVER DISORDERS 

30.01 cirrhosis 

30.02 other liver disorders (e.g., toxic hepatitis) 

31 DISEASES OF ESOPHAGUS 
31.01 disease of esophagus 

32 ULCERS 

32.01 ulcer without perforation 

32.02 ulcer with perforation 

33 GASTRITIS/OTHER GASTRIC DISORDERS 

33.01 pyloric/duodenal obstruction 

33.02 gastritis/other gastnc disorder (stomach disorders) 

34 APPENDICITIS 
34,01 appendicitis 

35 ABDOMINAL HERNIA/ COMPLICATED 
35,01 alxJominal hernia, complicated 



918 


18,716 


658 


107 


2,779 


16.279 


439 


142 


2,942 


15,369 


439 


155 


274 


32,368 


2,009 


103 


1,235 


24,697 


964 


137 


559 


20,078 


1,251 


147 


490 


26,667 


1,480 


123 


2,668 


14,476 


441 


157 


7,737 


11,956 


245 


180 


1,190 


15912 


531 


115 


28,669 


8,021 


88 


185 


2,456 


17,340 


412 


118 


21,469 


9,660 


120 


182 


1,009 


17,668 


824 


148 


2.454 


18,149 


436 


119 


822 


18,863 


804 


122 


89,484 


8,926 


55 


184 


263 


13,832 


841 


99 


862 


15,764 


756 


141 


413 


16,884 


758 


91 


1,690 


12,312 


428 


143 



c!cg\^naMablefvrjfnd 



TABLE H-1 

1992 MEDICARE PROGRAM EXPENDITURES AND 1992 FREQUENCY OF ENROLLEES FOR 
CONCURRENT PRINCIPAL INPATIENT DIAGNOSTIC GROUPS (UPPER CASE LABELS) 
AND HOSPITAL AND PHYSICIAN DIAGNOSTIC GROUPS {LOWER CASE LABELS) 



DXG 



Label 



GASTROINTESTINAL DISORDERS 



(continued) 



36 
3601 



42 
42,01 



ABDOMINAL HERNIA/ UNCOMPLICATED 
abdominal hernia/uncomplicated 



37 INFLAMMATORY BOWEL DISEASE 

37.01 regional enteritis (Crotin's disease) 

37.02 ulcerative colitis 

38 PERITONITIS/INTESTINAL OBSTRUCTION 

38.01 Intestinal ot)stnjction 

38.02 pentonitis 

38.03 otfier peritoneal disorders 

39 DIVERTICULA OF INTESTINE 
39.01 divercula of intestine 

40 ANAURECTAL/GASTROINTESTINAL DISORDERS 
40.01 tiemofThoids 

40 02 anal/rectal disorders 

40 03 intestinal abcess/uloeration/perforation 

40.04 other intestinal disorders 

41 GALLBLADDER DISORDERS 

41.01 cholelithiasis (gallstones) 

41.02 biliary tract disease 

41.03 other gallbladder disorders 



GASTROINTESTINAL HEMORRHAGE 
gastrointestinal hemorrtiage 







Standard 


Coefficient 




Mean 


Error 


of Variation 


Frequency' 


Expenditures" 


of Mean 


(X 100) 


1,473 


11,053 


394 


137 


30,310 


7.547 


74 


172 


216 


20,352 


1,987 


143 


1,451 


10089 


498 


188 


1.570 


9,127 


426 


185 


2,846 


20,748 


423 


109 


13,724 


19.016 


220 


135 


1.252 


34.754 


1,235 


126 


1,643 


19.315 


561 


118 


2.395 


15.307 


354 


113 


34,958 


6895 


68 


185 


2,059 


17,258 


490 


129 


17,830 


5,060 


80 


211 


21,175 


7,141 


97 


193 


3.598 


17,101 


445 


156 


28,027 


9,149 


S8 


179 


3,876 


15,085 


257 


106 


8,814 


11,933 


193 


152 


1,984 


20,264 


619 


136 


11,025 


12.949 


183 


149 


1,779 


19,583 


491 


106 


25,990 


12,556 


134 


172 



DISEASES OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE 



43 GOUT/ARTHROPATHY/DERANGEMENTS 

43.01 gout/crystal arthropathy 

43.02 other arthropathy/joint disorders, derangements 

44 CONNECTIVE TISSUE LoEASES 

44 01 systemic lupus erythematosus, scleroderma, artentis. and other connective tissue disease 

44 02 rheumatoid arthntis and other inflammatory polyarthropathy 

44 03 inflammatory spondylopathies 
44.04 polymyalgia rtieumatica 

45 ARTHROPATHY/BONE INFECTION 

45 01 arthropathy with infection 
45.02 osteomyelitis 

46 OSTEOARTHRITIS 
46.01 osteoarthrosis 

47 BACK PAIN 

47.01 back disorders (e.g., slipped disk, lumbago, sciatica, backache) 

48 DISORDERS OF SOFT TISSUES 

48.01 disorders of soft tissue (e.g., tendonitis, bursitis) 

49 OTHER BONE DISORDERS 
49.01 osteoporosis 

49 02 other bone disorders (eg,, curvature of spine, Pagefs disease) 

49 03 flat foot, acquired deformities of toe 

49.04 other acquired limb deformities 



642 


19.548 


714 


93 


12.755 


6.047 


103 


1S3 


109.190 


6,573 


38 


ISO 


578 


21,152 


823 


94 


5,277 


8,048 


226 


204 


14,329 


6,584 


111 


202 


1,999 


6,748 


293 


194 


3,914 


6,396 


210 


206 


472 


30,087 


1,382 


100 


1.240 


14,454 


619 


151 


3.618 


17,102 


414 


146 


4.006 


18,708 


213 


72 


115.431 


5.440 


31 


196 


2,737 


15.302 


259 


89 


96,367 


6,049 


38 


195 


650 


17,405 


927 


136 


103.996 


6,279 


39 


203 


1,754 


21,216 


477 


94 


19,302 


8,828 


108 


171 


20869 


8,917 


103 


166 


14,663 


5.202 


85 


193 


3,885 


11,853 


306 


151 



dcg'i^fiaiMablervVfmd 



TABLE H-1 

1992 MEDICARE PROGRAM EXPENDITURES AND 1992 FREQUENCY OF ENROLLEES FOR 
CONCURRENT PRINCIPAL INPATIENT DIAGNOSTIC GROUPS (UPPER CASE LABELS) 
AND HOSPITAL AND PHYSICIAN DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXG 



DISEASES 

50 


50.01 


51 


51.01 


51,02 


51.03 


51.04 


51.05 


51.06 


51.07 


5108 



Label 



DISEASES OF BLOOD AND BLOOD-FORMING ORGANS 



ANEMIA 

iron deficiency and other anemias 

OTHER BLOOD DISEASES 

sickle cell and other hereditary hemolytic anemias 

acquired hemolytic anemia 

aplastic anemia 

hemophilia and other coagulation defects 

purpura/thromtxjcytopathy/hemorrhagic conditions 

white blood cell disorders 

immune disorders 

other blood disease 



Frequency* 



1,020 
66,030 

875 

982 

629 

2,308 

6.644 

4,582 

5,487 

732 

6,529 



Mean 
Expenditures*' 



19.874 
11.599 

29,986 
12,309 
16,474 
22,198 
14,134 
16,621 
17,515 
15,456 
10,380 



Standard 

Error 
of Mean 



667 

71 

1,056 
805 
841 
580 
293 
407 
346 

1,073 
214 



CoefTicient 

of Variation 

(X 100) 



107 

157 

104 
205 
128 

126 

159 
166 
146 
188 
157 



MENTAL DISORDERS 



52 DEMENTIA 

52.01 senile/presenile psychoses 

52 02 other organic psychotic conditions 

52.03 cerebral degeneration/Alzheimer's disease/Reye's syndrome 

52.04 senility without psychosis 

53 SUBSTANCE-RELATED PSYCHOSES 

53 01 alcoholic psychoses 

53.02 drug psychoses 

54 DELIRIUM/HALLUCINATIONS 

54.01 delirium/delusions/hallucinations 

54.02 hallucinations, symptomatic 

55 SCHIZOPHRENIC DISORDERS 

55 01 schizophrenic disorders 

56 MANIC AND DEPRESSIVE DISORDERS 

56 01 manic and depressive disorders, including major depressive disorder 

57 PARANOIA AND OTHER PSYCHOSES 

57.01 paranoid states 

57.02 other nonorganic psychoses 

56 NEUROTIC DISORDERS 

58 01 neurotic disorders (e.g anxiety, panic attack, phobias) 

59 SUBSTANCE ABUSE AND DEPENDENCE 
59.01 alcohol dependence 

59 02 drug dependence 

59.03 non-dependent abuse of drugs 

60 OTHER MENTAL DISORDERS 

60.01 personality disorders 

60.02 sexual deviations and disorders 

60.03 psychophysralogic disorders 

60.04 acute reaction to stress 

60 05 adjustment reaction 

60.06 nonpsychotic organic brain syndrome 

60.07 depression, not elsewhere classified 

60.08 behavior disorder 

60 09 developmental behavioral disorders 

60.10 mental retardation 

60. 1 1 other mental disorders 



1,595 


18,709 


432 


92 


19,373 


10363 


111 


149 


3,057 


13,478 


346 


142 


15,417 


11,482 


144 


156 


1,381 


8,125 


357 


163 


347 


16,654 


814 


91 


1,131 


13981 


518 


125 


1,077 


17,645 


623 


116 


485 


19,854 


918 


102 


4,954 


18,287 


326 


125 


772 


12,355 


534 


120 


1,668 


15,624 


342 


89 


8,476 


7,173 


137 


176 


2,542 


19,341 


332 


87 


13,282 


10,798 


146 


156 


695 


16,735 


586 


92 


868 


11,521 


537 


137 


15,284 


12,239 


139 


140 


391 


18,667 


938 


99 


28.674 


7,401 


79 


181 


831 


13511 


446 


95 


3,410 


12,760 


311 


142 


977 


15,518 


588 


118 


5,830 


9,921 


190 


146 


805 


17,490 


717 


115 


2,014 


12,555 


373 


133 


1,396 


4,456 


239 


201 


925 


8,824 


440 


152 


1,686 


6,667 


356 


219 


4,152 


12,767 


342 


172 


9,019 


11.310 


179 


150 


14,429 


9,705 


136 


168 


727 


8,544 


553 


175 


874 


9,791 


586 


177 


3,739 


4,386 


174 


242 


2,232 


9,749 


333 


161 



clcg'JinaM3t)iefvl\Imd 



TABLE H-1 

1992 MEDICARE PROGRAM EXPENDITURES AND 1992 FREQUENCY OF ENROLLEES FOR 
CONCURRENT PRINCIPAL INPATIENT DIAGNOSTIC GROUPS (UPPER CASE LABELS) 
AND HOSPITAL AND PHYSICIAN DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXG 



Label 



NEUROLOGICAL DISORDERS 

61 HEADACHES 

61.01 headaches, Including migraine 

62 DEGENERATIVE NEUROLOGIC DISORDERS 

62.01 Parkinson's disease 

62.02 Huntington's Disease, essential tremor, other abnonnai movement disorders 

62.03 anterior horn cell disease, including Lou Gehrig's disease (ALS) 

62.04 other spinal cord disease 

62.05 autonomic nerve disorder 

62.06 other hereditary and degeneratrve central nervous system diseases (e.g., Tay-Sachs) 



63 
63.01 
63.02 
63.03 
63.04 
63.05 
63 06 
63.07 
63.08 

64 
64.01 

65 
65.01 
65 02 
6503 

65 04 
65.05 
6506 
65.07 

66 
66.01 

66 02 

66,03 
66 04 
66 05 

67 



OTHER NEUROLOGIC DISORDERS 

multiple sclerosis, other central nervous system dymelination 

infantile cerebral palsy 

quadriplegia 

paraplegia 

Cauda equina syndrome 

other paralytic disorders 

nervous/musculoskeletal system symptoms 

other central nervous system disorders 

EPILEPSY AND OTHER SEIZURE DISORDERS 
epilepsy and other seizure disorders/convulsions 

MONONEUROPATHY 

trigeminal nerve disorder 

facial nerve disorders, including Bell's Palsy 

root/plexus disorders 

root/plexus lesions 

other cranial nerve disorders 

neuropathy of upper limb (e.g., carpal tunnel syndrome) 

neuropathy of leg 

POLYNEUROPATHY 

peripheral neuropathy 

inflammatory/toxic neuropathy, including Gullain-Barre Syndrome 

myoneural disorders.'myasthenia gravis 

muscular dystrophies 

other neuropathy 



CEREBRAL CYSTS, COMPRESSION, EDEMA, ANOXIC DAMAGE, 
OTHER BRAIN CONDITIONS 
67 01 cerebral cysts, compression, edema, anoxic damage, other brain conditions 







Standard 


Coefficient 




Mean 


Error 


of Variation 


Frequency 


Expenditures'* 


of Mean 


(X 100) 


151 


12.287 


1,146 


115 


26,664 


6.997 


82 


191 


522 


20.611 


840 


93 


9,313 


8,026 


148 


178 


3,777 


8.127 


243 


184 


497, 


14.410 


1,186 


183 


1,204 


15,824 


609 


134 


1,463 


12,743 


508 


152 


703 


11.017 


673 


162 


480 


24,498 


1,019 


91 


1,692 


9.036 


400 


182 


1,002 


6.110 


422 


219 


705 


20.250 


1,128 


148 


954 


19.354 


858 


137 


3,607 


13.617 


323 


142 


1,375 


17.362 


622 


133 


10,723 


12.073 


171 


147 


1,365 


18,124 


695 


142 


1,368 


19,610 


560 


106 


16,432 


10,702 


149 


179 


210 


17,000 


1,035 


88 


1.415 


5812 


281 


182 


1,639 


6,856 


289 


171 


634 


7,583 


628 


208 


582 


7,870 


518 


189 


336 


10,438 


953 


167 


6.628 


6,060 


143 


192 


6.783 


7,383 


153 


182 


193 


27,266 


2,199 


112 


5.776 


9,277 


207 


169 


3,179 


13567 


361 


150 


646 


11,149 


724 


165 


859 


14,208 


916 


189 


824 


9,190 


612 


191 


182 


26.460 


1,929 


98 


6.177 


20,559 


376 


144 



CIRCULATORY DISORDERS 



68 VALVULAR AND RHEUMATIC HEART DISEASE 

68.01 rheumatic fever/heart disease 

68.02 mitral or aortic valve/endocardia disease 

68.03 mitral/aortic vatve disorders 

69 HYPERTENSION. UNCOMPLICATED 
69 01 essential hypertension 

69 02 hypertensive heart disease 

70 HYPERTENSION. COMPLICATED 

70.01 malignant hypertension 

70.02 malignant hypertensive heart disease 

70.03 hypertensive heart and renal disease 

70.04 secondary hypertension 

70.05 hypertension encephalopathy 

71 MYOCARDIAL INFARCTION (SUBSEQUENT EPISODE OF CARE) 

71.01 myocardial infarction (heart attack), subsequent episode of care 

71.02 old myocardial infarction (heart attack) 

71 .03 coronary atherosclerosis, aneurysm of heart, other chronic ischemic heart disease 



791 


39,750 


1.415 


100 


4.000 


14,157 


363 


162 


32.667 


11,650 


103 


160 


6.860 


14,827 


245 


137 


1.449 


18.554 


542 


111 


241.606 


5,121 


23 


219 


27,676 


7.870 


86 


181 


872 


19.471 


796 


121 


18,041 


6.336 


98 


206 


3,000 


7.965 


291 


200 


4,201 


17.100 


413 


157 


714 


10.013 


583 


156 


1.179 


12,569 


560 


153 


3,988 


27,839 


374 


85 


13,585 


17,273 


194 


131 


11,091 


12,879 


166 


136 


124,428 


8,403 


43 


182 






dcg\/in) 


6 

^^Tab^eh-Umd 



TABLE H-1 

1S32 MEDICARE PROGRAM EXPENDITURES AND 1992 FREQUENCY OF ENROLLEES FOR 
CONCURRENT PRINCIPAL INPATIENT DIAGNOSTIC GROUPS (UPPER CASE LABELS) 
AND HOSPITAL AND PHYSICIAN DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



OXG 



Label 



CIRCULATORY DISORDERS 



(continued) 



72 

72.01 



ACUTE MYOCARDIAL INFARCTION (INITIAL EPISODE OF CARE) 
acute myocardial infarction (heart attack), initial episode of care 



73 OTHER ACUTE ISCHEMIA 
73.01 other acute ischemia 

74 ANGINA PECTORIS 

74 01 angina pectoris 

75 PULMONARY HEART DISEASE 

75 01 pulmonary embolism (blood clot) 

75 02 other pulmonary heart disease 

76 RHYTHM AND CONDUCTION DISORDERS 

75.01 conduction disorders^cardiac dysrhythmias 

76 02 premature heart t)eats 

77 ATRIAL ARRYTHMIA 

77 01 atnal arrhythmia 

78 VENTRICULAR TACHYCARDIA 

78 01 ventric tachycardia 

79 HEART ARREST/ SHOCK 

79 01 heart arrest/shock 

80 HEART FAILURE 
60 01 heart failure 

81 OTHER CARDIAC DISEASE 
81 01 pericarditis. post-MI 

8102 acute endo/myocarditis 

81 03 cardiomyopathy/myocarditis 

Bl 04 cardiomegaly (enlarged heart) 

81.05 other heart disease 

82 CEREBRAL HEMORRHAGE 

62 01 cerebral hemorrhage 

83 PRECEREBRAL ARTERIAL OCCLUSION 

63 01 precerebral arterial occlusion 

84 CEREBROVASCULAR DISEASE (STROKE) 
84 01 cerebrovascular accident (stroke) 

64.02 hemiplegia (paralysis of one side of body) 

84 03 aphasia (loss of language skills/comprehension) 

85 TRANSIENT CEREBRAL ISCHEMIA 
85.01 transient cerebral ischemia 

86 ATHEROSCLEROSIS 

86.01 atherosclerosis of aorta, renal artery, and arteries of the extremities 

86.02 atherosclerosis/general, arteriosclerotic cardiovascular disease/artenosclerosis 

87 ANEURYSM 

87 01 aortic aneurysm 

87,02 other aneurysm 

88 ARTERIAL EMBOLISM AND THROMBOSIS 

63,01 arterial embolism and thromtx5sis (blood clots) 







Standard 


Coefficient 




Mean 


Error 


of Variation 


Frequency" 


Expenditures" 


of Mean 


(X 100) 


6,450 


22,516 


278 


99 


9,266 


22,149 


252 


109 


7,275 


19,338 


235 


104 


21,664 


15,828 


139 


129 


2,128 


15,395 


376 


113 


44,191 


9,806 


74 


159 


791 


22,880 


718 


88 


3,438 


20,696 


439 


124 


6,277 


15713 


292 


14? 


2,S98 


16,457 


283 


94 


60,255 


9,644 


67 


171 


13,292 


9,804 


136 


150 


3,358 


14,823 


282 


110 


43,505 


11,915 


93 


163 


517 


27,365 


1,212 


101 


5,332 


19,583 


355 


132 


291 


34,724 


2,001 


58 


8,336 


23,121 


360 


142 


11,168 


21,290 


208 


103 


75,085 


12,569 


74 


161 


693 


27,236 


953 


93 


2,586 


20,433 


530 


132 


712 


22,656 


1,145 


135 


11,768 


14,703 


195 


144 


23,604 


14,847 


133 


143 


12,852 


12,160 


173 


151 


1,093 


26,850 


869 


107 


4,189 


18,861 


372 


123 


1,489 


17,261 


388 


87 


17,454 


11,076 


129 


154 


7,526 


22,023 


249 


98 


41.769 


12,336 


95 


157 


7,520 


19,579 


250 


111 


2,358 


20,077 


433 


105 


2,548 


12,316 


266 


109 


19,573 


9,937 


104 


147 


892 


30,285 


808 


80 


20.211 


11,466 


131 


152 


41,221 


9,311 


78 


171 


1,030 


32,586 


1,073 


1C6 


7.025 


13,449 


263 


164 


1,868 


18,480 


619 


145 


982 


29,422 


803 


85 


6.377 


19,200 


322 


134 



dcg'/inaMableh- 1 'irrd 



TABLE H-1 

1992 MEDICARE PROGRAM EXPENDITURES AND 1992 FREQUENCY OF ENROLLEES FOR 
CONCURRENT PRINCIPAL INPATIENT DIAGNOSTIC GROUPS (UPPER CASE LABELS) 
AND HOSPITAL AND PHYSICIAN DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXG 



Label 



CIRCULATORY DISORDERS 



(continued) 



89 PERIPHERAL VASCULAR DISEASE 
89.01 specified peripheral vascular disease 
89 02 Raynaud's syndrome 

89.03 peripheral vascular disease 

89.04 other arterial disease 

69.05 disease of capillaries 

89.06 vascular insufficiency of intestines 

89.07 gangrene 

90 THROMBOPHLEBITIS • 

90.01 phlebitis and thrombophlebitis 

90.02 noninfectious lymphatic disorders 

90.03 hemorrhage nos 

90.04 compression of vein 

91 HYPOTENSION (LOW BLOOD PRESSURE) 
91.01 hypotension (low blood pressure) 

92 OTHER CIRCULATORY DISEASE 

92.01 superficial phlebitis-leg 

92.02 varicose veins 

92.03 other circulatory disease/postphlebitic syndrome 
92 04 other specified circulatory disorders 







Standard 


Coefficient 




Mean 


Error 


of Variation 


Frequency* 


Expenditures'* 


of Mean 


(X 100) 


1,179 


29,863 


812 


93 


3.082 


13,762 


406 


164 


948 


7,505 


526 


216 


30,616 


10,022 


97 


169 


6,846 


13,983 


266 


157 


918 


5,818 


429 


223 


1,550 


23,079 


882 


150 


3,370 


28,232 


545 


112 


1,663 


19,384 


470 


99 


13,716 


13,742 


179 


153 


1,511 


10,205 


412 


157 


1,126 


18,424 


915 


167 


933 


14,444 


713 


151 


599 


16,719 


733 


115 


8,113 


16467 


267 


145 


479 


18,897 


910 


105 


1,949 


10,011 


363 


150 


9,265 


7,303 


138 


182 


5,777 


14,065 


294 


159 


8,196 


10,163 


196 


174 



DISORDERS OF THE EYE AND ADNEXA 



93 DISORDERS OF THE EYE AND ADNEXA 

93 01 diabetic retinopathy 

93.02 proliferative diabetic retinopathy 

93.03 endophthalmitis (eye inflammation) 

93.04 retinal disorders 

93.05 glaucoma 

93.06 cataract/lens replacement 

93 07 disorders of refraction and accommodation (e g , far-, near-sightedness, astigmatism) 

93 08 vitreous hemorrhage 

93 09 other eye disorders 



945 


11,118 


492 


136 


9,906 


7,631 


133 


174 


1,909 


9,150 


336 


161 


520 


8,970 


673 


171 


54,643 


4,576 


41 


208 


56,024 


4,030 


38 


223 


177,409 


4,026 


21 


217 


22,684 


3,437 


53 


230 


1,414 


7,085 


293 


156 


118,492 


4,491 


28 


218 



DISORDERS OF THE EAR AND MASTOID PROCESS 



94 EAR DISORDERS 

94 01 impacted earwax 

94 02 otitis media (middle ear infection) 

94.03 vertiginous syndromes (e g., vertigo, Meniere's disease) 

94.04 heanng loss 

94.05 other ear disorders 



494 


8,630 


453 


119 


27.319 


4,053 


55 


224 


16,385 


4,286 


75 


224 


11,455 


4,569 


85 


198 


17,444 


5,090 


81 


211 


20,486 


4,508 


69 


220 



DISEASES OF THE RESPIRATORY SYSTEM 



95 NOSE/ THROAT DISEASES 

95.01 acute nose/throat infection (eg., common cold) 

95.02 nasal polyps/allergic rhinitis (e.g., hay fever) 

95.03 chronic sinusitis 

95.04 larynx/vocal cord diseases 
95 05 paralysis of vocal cords/larynx 

95.06 disorders of teeth, gum, and jaw (eg , periodontitis, gingivitis) 

95.07 other diseases of upper respiratory system 
P5.08 salivary gland diseases 

95 09 oral soft tissue/tongue/jaw disorders 

96 EMPHYSEMA/CHRONIC BRONCHITIS 
96.01 emphysema/chronic bronchitis 

97 OTHER BRONCHITIS 
97.01 other tironchitis 



599 


16,074 


819 


125 


76,452 


4,450 


37 


233 


23,138 


3,799 


55 


219 


20,774 


4,690 


73 


223 


2,141 


9,523 


466 


226 


551 


21,675 


1,382 


150 


5,106 


6,443 


191 


211 


12,132 


5,530 


111 


221 


1,824 


7,112 


428 


257 


4,714 


6,595 


198 


206 


4,511 


20,230 


332 


110 


80,841 


9,585 


61 


180 


1,553 


15,763 


433 


108 


74,211 


5,968 


46 


208 



OcgVinaMabieh-rimd 



TABLE H-1 

1992 MEDICARE PROGRAM EXPENDITURES AND 1992 FREQUENCY OF ENROLLEES FOR 
CONCURRENT PRINCIPAL INPATIENT DIAGNOSTIC GROUPS (UPPER CASE LABELS) 
AND HOSPITAL AND PHYSICIAN DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXG 



Label 



DISEASES OF THE RESPIRATORY SYSTEM (continued) 

98 VIRAL PNEUMONIA/INFLUENZA 

98.01 viral pneumonia 

98.02 influenza 

99 GRAM-NEGATIVE/STAPHYLOCOCCUS PNEUMONIA 
99.01 gram-negative/staph pneumonia 

100 BACTERIAL PNEUMONIA 

100.01 pneumococcal and other specific bacterial pneumonia 

100.02 other and unspecified pneumonia 



101 
101.01 



ASTHMA 
asthma 



1 02 LUNG DISEASES DUE TO EXTERNAL AGENTS 

102.01 bronchiectasis, lung diseases due to specified external agent (e.g., black lung disease) 

102.02 aspiration pneumonia 

102.03 respiratory conditiora due to other and unspecified external agents/postinflammatory fibrosis 



103 PLEURISY/PNEUMOTHORAX 
10301 pleunsy/pneumothorax 



104 OTHER LUNG DISEASE 

104.01 empyema/abscess of lung 

104.02 pulmonary congestion/hypostasis 

104.03 acute lung edema not elsewhere specified 

104.04 post trauma/surgery pulmonary insufficiency 

104.05 other lung disease 

105 RESPIRATORY FAILURBARREST 

105.01 respiratoryfailure 

105.02 respiratory arrest 







Standard 


CoefTicient 




Mean 


Error 


of Variation 


Frequency* 


Expenditures" 


of Mean 


(X 100) 


262 


15,319 


1,813 


192 


2.564 


16,293 


477 


148 


8,261 


7,096 


173 


222 


2,155 


28,506 


666 


108 


3,985 


30,787 


658 


135 


9,277 


19,236 


229 


115 


4,033 


18,730 


414 


140 


41.993 


15,328 


119 


159 


1,575 


17,748 


570 


128 


23,151 


7,848 


98 


190 


1,681 


32,513 


764 


S6 


3.166 


10,432 


317 


171 


3,790 


31,292 


622 


122 


7,313 


12,952 


240 


158 


731 


24,174 


835 


94 


18,772 


22,763 


210 


12S 


673 


30.528 


1,422 


121 


890 


23,840 


1,178 


147 


12,515 


17,709 


233 


147 


3176 


27,583 


591 


121 


1,855 


42,967 


1,164 


117 


28,408 


17,924 


152 


143 


1,746 


37,674 


1,101 


122 


24,115 


21,035 


207 


153 


4,212 


40,009 


791 


128 



DISEASES OF THE GENITOURINARY SYSTEM 



106 REI^L FAILURE 

106.01 nephritis, dialysis encounter 

106.02 acute renal failure 

106.03 chronic renal failure 

106.04 renal failure, unspecified 

106.05 impaired renal function 

107 KIDNEY INFECTION 
107.01 kidney infection 

108 REfWLAJRETERAL/BLADDER CALCULUS 
108.01 renaiyureteral/bladder calculus (e.g.. kidney stones) 

109 OTHER RENALAJRETERAL DISEASES 

109.01 urethral stricture 

1 09. 02 hydronephrosis/other renal/urethral disorders 

110 OTHER URINARY TRACT INFECTIONS 
110.01 cystitis, other urinary tract infectcns 

1 1 1 OTHER URll^RY DISORDERS 
1 1 1 .01 other unnary disorders 

112 PROSTATE/TESTICULAR/PENILE DISORDERS 

1 12.01 hyperplasia of prostate 

1 12.02 other prostatic disorders 

11 2.03 penis/testis/male genital organs disorders 



952 


28,878 


1,234 


132 


2.931 


17.830 


453 


138 


4.696 


33,360 


632 


130 


6.185 


20,341 


389 


151 


6.208 


19,463 


372 


151 


1,471 


12.887 


503 


150 


614 


14.476 


649 


111 


4,272 


11,247 


253 


147 


802 


10.899 


379 


99 


7,052 


8,893 


189 


178 


347 


17,757 


847 


89 


5,866 


8,100 


183 


173 


16,744 


13,640 


158 


150 


3,755 


21,030 


347 


101 


88,343 


9,108 


55 


180 


587 


16,852 


799 


115 


29,781 


9,292 


90 


168 


3,345 


10,266 


216 


122 


48,567 


5,327 


51 


213 


15,857 


5,347 


79 


187 


8,631 


6,521 


137 


196 



dcgNfirtaMabierv 1 ~imd 



TABLE H-1 

1992 MEDICARE PROGRAM EXPENDITURES AND 1992 FREQUENCY OF ENROLLEES FOR 
CONCURRENT PRINCIPAL INPATIENT DIAGNOSTIC GROUPS (UPPER CASE LABELS) 
AND HOSPITAL AND PHYSICIAN DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXG 



Label 



DISEASES OF THE GENITOURINARY SYSTEM 



(continued) 



113 DISEASES OF FEMALE GENITAL ORGANS 

113.01 diseases of female pelvic organs, including pelvic inflammatory disease, endometriosis, 
ovarian cyst 

1 1 3.02 vaginal and cervical diseases 

1 1 3 03 otfier diseases of female genital organs 

113.04 female stress incontinence 

113.05 menopausal and postmenopausal disorders 

114 GENITAL PROLAPSE 
114.01 genital prolapse 







Standard 


Coefficient 




Mean 


Error 


of Variation 


Frequency* 


Expenditures" 


of Mean 


(X 100) 


684 


11,532 


564 


128 


5,018 


8,645 


208 


171 


16,212 


4,457 


79 


227 


10,033 


6,702 


126 


188 


3,998 


6,084 


156 


162 


27,600 


3210 


46 


235 


1,111 


6,725 


180 


89 


7,565 


4,257 


93 


190 



PREGNANCY-RELATED CONDITIONS 



115 PREGNANCY/PERINATAL CONDITIONS 

115.01 pregnancy/birth complications, mother/child 

115.02 pregnancy with atxjrtive outcome 
115 03 normal pregnancy/delivery 



120 


7,175 


805 


123 


3,896 


10,675 


322 


188 


174 


11,327 


1,661 


193 


361 


7,175 


746 


197 



DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE 



115 DERMATOLOGICAL DISORDERS 

116.01 cellulitis/abscess/other local skin infection 

1 1 6. 02 bullous dermatoses 

1 1 7 CHRONIC ULCER OF SKIN 
117.01 chronic ulcer of skin 

1 1 8 OTHER DEMATOLOGICAL DISORDERS 

118.01 dermatitis due to internal agent 

1 18.02 psoriasis and similar disorders 

1 1 3.03 other dermatosis 

118.04 diseases of nail (eg, ingrown toenail) 

118.05 other dermatological disorders 



2,383 


17,987 


395 


107 


43,600 


8,403 


76 


188 


726 


8,353 


570 


184 


1,132 


32,993 


790 


81 


21,094 


13,887 


149 


155 


205 


17,075 


1,052 


88 


1.660 


11,194 


431 


175 


4,939 


4,896 


154 


236 


50,974 


3,445 


34 


224 


39,841 


6,879 


65 


189 


89,143 


4,710 


35 


222 



CONGENITAL ANOMALIES 

119 CONGENITAL ANOMALIES 

1 19 01 spina bifida, other congenital anomalies of nervous system 

119.02 congenital anomalies of eye 

1 19.03 congenital anomalies of cardiac/circulatory systems 

1 1 9.04 congenital anomalies Of musculoskeletal/limb 

119.05 congenital anomalies of skin 

1 19.06 Down's syndrome and other chromosomal anomalies 

1 19.07 other congenital anomalies 

SYMPTOMS. SIGNS, ILL-DEFINED CONDITIONS 



167 


24,261 


1,659 


88 


1,228 


12,643 


556 


154 


2,186 


4,845 


251 


242 


8,271 


12,741 


235 


158 


5,533 


8,382 


201 


179 


2,792 


5,149 


211 


216 


727 


3,795 


433 


308 


6,448 


10,211 


231 


131 



120 GENERAL SYMPTOMS 

120.01 somatio/segmental dysfunction 

120.02 dizziness and giddiness 

120.03 malaise and fatigue 

120.04 other general symptoms 

121 COMA/ SYNCOPE 
12101 coma 

121 02 syncope (fainting) and collapse 

122 FEVER 
12201 fever 

123 RESPIRATORY/OTHER CHEST SYMPTOMS 

123.01 dyspnea (labored breathing)/other respiratory abnonnalities 

123.02 hemoptysis (coughing up blood) 

123.03 cough 

123.04 respiratory/other chest symptoms 



983 


19,244 


586 


112 


11,152 


3,968 


84 


223 


34,231 


6,096 


64 


195 


37,897 


8,075 


74 


177 


127.236 


8,233 


44 


189 


2,235 


13,450 


345 


121 


3,590 


21,579 


524 


145 


19,876 


10,347 


106 


145 


406 


22,211 


1,126 


102 


14,288 


18,289 


214 


140 


476 


16,761 


1,050 


137 


59,523 


12,949 


85 


160 


2,925 


13,564 


394 


157 


27,475 


7,329 


84 


190 


31,743 


12,014 


107 


159 



10 

dcg^fi naM abich- 1 ^md 



TABLE H-1 

1992 MEDICARE PROGRAM EXPENDITURES AND 1992 FREQUENCY OF ENROLLEES FOR 
CONCURRENT PRINCIPAL INPATIENT DIAGNOSTIC GROUPS (UPPER CASE LABELS) 
AND HOSPITAL AND PHYSICIAN DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXG 



Label 



SYMPTOMS, SIGNS, ILLJ3EFINED CONDITIONS (continued) 

124 CARDIOVASCULAR SYMPTOMS 

124.01 chest pain 

124.02 ottier cardiovascular symptoms 

125 URINARY SYSTEM/ABDOMINAL-PELVIS SYMPTOMS 

125.01 retention of urine 

125.02 incontinence/urettiral discharge 

125.03 other urinary system symptoms 

125.04 atxlominal/peMs symptoms 







Standard 


Coefficient 




Mean 


Error 


of Variation 


Frequency* 


Expenditures" 


of Mean 


(X 100) 


3.424 


11,668 


247 


124 


107.457 


9,511 


49 


169 


25.614 


8,171 


95 


166 


1.087 


15742 


519 


109 


10,291 


15,427 


197 


129 


9,264 


9,638 


161 


161 


23,292 


7,437 


99 


202 


90,850 


9.493 


56 


178 



INJURY AND POISONING 



126 VERTEBRAL INJURY 

126.01 vertebral fracture without spinal cord injury 

126.02 vertebral frac.e with spiral cord injury 

127 FRACTURES OF SKULUFACE/NASAL BONE 

127.01 fractures of skull/faoe 

127.02 fractures of nasal bone 

128 PELVIC FRACTURE 
128.01 pelvic fracture 

129 FEMORAL FRACTURE 
129 01 femoral fracture 

130 LOWER LIMB FRACTURES 

130.01 fractures of lower limb (e.g., leg ankle, foot) 

131 OTHER FfRACTURES/DISLOCATION 

131.01 shoulder dislocation 

131.02 dislocation of hip 

131.03 dislocation of knee, including cartilage/meniscus tear 

131.04 other dislocations 

131.05 fracture of rib, closed 

131.06 hand/wrist/lower arm fracture 
13107 other fractures 

1 32 INTERNAL AND/OR OPEN WOUND 

132.01 foreign body in pharynx/larynx 

132.02 injury to heart/lung/intralhoracic organs/blood vessels of thorax 

132.03 gastrointestinal/liver/kidney/spleen/pelvjs injury 

1 32.04 open wound of eye 

132.05 open v«5und/in)Ufy of tower arm 

132.06 open wound of other sites 

132.07 traumatic amputation of Iimb/hand/foot/toe 

132.08 crushing injury 

132.09 foreign body in eye/ear/nose 

133 SPRAINS 
13301 sprains 

1 34 CONTUSIONS/ACCIDENTS/INJURY. SUPERFICIAL AND NOS 

134.01 concussion 

134.02 contusion/superficial injury 

134.03 accidental falls 

134.04 suicide/self-inflicted injury 

134.05 other accidents 

135 INTRACRANIAL (HEAD) INJURY 
135.01 intracranial (head) injury 

136 BURNS/NERVE. SPINAL CORD INJURIES 

136.01 third degree burns 

136.02 other bums 

136.03 nerve injury, including spinal cord injury without vertebral fracture 

136.04 early complications of trauma 



735 


17,896 


686 


104 


6.005 


11,525 


213 


143 


651 


K,j66 


817 


145 


144 


22,502 


2,387 


127 


1,466 


13,464 


641 


182 


789 


8,390 


508 


170 


671 


17,307 


642 


95 


2,677 


14,284 


324 


117 


5718 


22,846 


220 


73 


12,028 


16,256 


159 


108 


924 


13,564 


421 


94 


8.410 


7,922 


146 


169 


1,368 


15026 


425 


104 


912 


8,401 


482 


173 


478 


21,276 


1,051 


108 


2,638 


5,780 


173 


154 


17,466 


3,853 


68 


232 


5,028 


9,606 


229 


169 


8.213 


6,756 


133 


178 


9,531 


9,450 


160 


165 


684 


20,299 


856 


110 


2,507 


15,558 


528 


170 


1,125 


18,169 


873 


161 


1,091 


16.946 


795 


155 


893 


8,083 


485 


179 


13,846 


5,675 


98 


204 


16,581 


9.222 


137 


191 


1,480 


24.968 


766 


118 


604 


7,572 


537 


174 


2,376 


4,185 


195 


228 


613 


10,707 


420 


97 


38,616 


5,085 


51 


198 


650 


15,792 


798 


129 


1,262 


10,498 


461 


156 


53,451 


7.513 


59 


182 


11,004 


10.925 


144 


138 


272 


17.650 


1,092 


102 


7,595 


7.918 


158 


174 


452 


26,727 


1,284 


102 


5,375 


13.276 


278 


154 


162 


28.977 


3.314 


146 


277 


14,600 


1,939 


221 


1,978 


8171 


397 


216 


1,873 


11,044 


421 


165 


1,276 


21,021 


891 


151 



INJURY AND POISONING 



(continued) 



11 
dcg'finaMaWeh- 1 ^md 



TABLE H-1 

1992 MEDICARE PROGRAM EXPENDITURES AND 1992 FREQUENCY OF ENROLLEES FOR 
CONCURRENT PRINCIPAL INPATIENT DIAGNOSTIC GROUPS (UPPER CASE LABELS) 
AND HOSPITAL AND PHYSICIAN DIAGNOSTIC GROUPS (LOWER CASE LABELS) 



DXG 



Label 



137 POISONING/TOXIC EFFECTS 

137.01 poisoning by prescription or over-the-counter medications 

137.02 poisoning by specified nonmedicinal substances/injury by certain external causes 

137.03 poisoning by other nonmedicinal substances 

137.04 allergy, unspecified 

137.05 adverse effects of correctly prescribed and administered dmgs in therapeutic use 

138 COMPLICATIONS OF MEDICAL PROCEDURES AND CARE 

1 38.01 malfunction of internal orthopedic device/graft 

138.02 infection/inflammation due to infernal device/graft, transplant failure/rejection 

138.03 other complications of certain specified medical procedures 

138.04 other complications of medical and surgical procedures, nee, 
(e.g.. post ooerative infection) 

138.05 misadventure or abnormal reaction/complication of patient during sugery or medical care 







Standard 


Coefficient 




Mean 


Error 


of Variation 


requency* 


Expenditures" 

17,811 


of Mean 


(X 100) 


882 


657 


110 


4,660 


14.766 


306 


142 


3,091 


11,075 


338 


170 


1,749 


3,642 


194 


223 


4,972 


4,933 


140 


2Q0 


13,316- 


11,578 


147 


145 


4,439 


27,768 


389 


93 


1,819 


18,019 


436 


103 


1,913 


30,948 


805 


114 


7,359 


22,602 


317 


120 


17.710 


23,191 


206 


118 



1,270 



22,014 



600 



FACTORS INFLUENCING HEALTH STATUS/CONTACT WITH HEALTH SERVICES (V-CODE) 

139 ORGAN REPLACEMENT/TRANSPLANT/POST-SURGICAL STATES 
139.01 kidney, heart, heart valve (human/animai tissue), lung, liver transplant 

139 02 other organ transplant 

139.03 heart, heart valve replacement by artificial device 

139.04 joint replacement 

139.05 other organ replacement 

139.06 artificial opening status/attention 

139.07 postsurgical states, eye 

139.C3 other postsurgical states, including dialysis status 

139.09 aspirator, respirator, other machine dependence 

140 REHABILITATION PROCEDURES 

140 01 rehabilitation procedures 

141 RADIOTHERAPY 
141.01 radiation therapy 

142 CHEMOTHERAPY 
142.01 chemotherapy 

143 HISTORY OF DISEASBAFTERCARBSCREENING 

143.01 infectious disease contact/earner 

143.02 vaccination, medical exam, other preventive 

1 43.03 history of malignant neoplasm 

143.04 history of mental disorder/other disease 

143.05 history of drug allergy/other health hazard 

143.06 family history of disease 

143.07 problems of internal organs/external sites 
1 43 08 elective surgery 

143.09 prothesis/other device fitting, adjustment 

143.10 other orthopedic aftercare 

143.11 aftercare 

143.12 donor 

1 43. 1 3 household/family/other psychosocial circumstances 

143. 14 care not delivered 

143.15 administrative/consultation 

1 43. 1 6 screening for malignant neoplasm 

143. 17 soreening/obsen/ation/special exams 



583 


29,464 


1,085 


39 


539 


22,365 


1,596 


*66 


895 


8,164 


630 


231 


2,397 


14,876 


489 


161 


5,949 


15,966 


218 


1C5 


416 


17,552 


1,341 


155 


4,398 


25,253 


500 


131 


298 


13,478 


816 


105 


21,008 


14,947 


142 


138 


380 


71,286 


4,681 


123 


4,340 


31,800 


349 


72 


10,961 


19,601 


208 


111 


148 


31,087 


1,752 


69 


4,266 


15,245 


269 


t 'i5 


935 


34,281 


772 


59 


3,437 


20,596 


382 


109 


1,218 


24.425 


701 


100 


674 


4,686 


347 


192 


38,764 


4,297 


50 


230 


22,650 


9,230 


98 


160 


6,998 


10,849 


194 


150 


6,696 


7,440 


174 


191 


4,769 


4,167 


135 


223 


1,244 


9,556 


518 


189 


321 


8,360 


707 


152 


2,091 


12,765 


454 


163 


2,468 


13,060 


326 


124 


6,543 


13,681 


264 


156 


343 


19,230 


1,206 


116 


539 


9,812 


606 


143 


1.831 


12,374 


403 


140 


3.457 


8,148 


259 


187 


26.841 


3,141 


47 


247 


267.301 


6.820 


26 


200 



* Unweighted. 

** Weighted by Traction of year beneficiary was aive and eigible for Medicare. 



i^URCE: 1992 (expenditures) and 1992 (dagrwses) Medcare claims 



12 
dcg\i'inai\TabiefV' i 'imc: 



TABLE H-2 

REGRESSION OF 1992 MEDICARE PROGRAM EXPENDITURES ON 1992 HOSPITAL AND PHYSICIAN 
(ALL) DIAGNOSIS DIAGNOSTIC GROUPS 









SUM OF 


MEAN 






SOURCE 




OF 


SQUARES 


SQUARE 


F VALUE 


PROB>F 


MODEL 




442 


3.87E+13 


8.75E+10 


1742.329 


0.0001 


ERROR 




679,745 


3.41 E+1 3 


50202860 






C TOTAL 




680,187 


7.28E+13 








ROOT MSE 


7.085 


R-SQUARE 


0.5312 






DEP MEAN 




3,783 


ADJ R-SQ 


0.5309 






C.V. 




187 
















PARAMETER 


STANDARD 


T FOR HO: 


VARIABLE 


ADDXG 


VARIABLE 


OF ESTIMATE 


ERROR 


PARAMETER=0 


PROS > ITI 




Intercept 




($150) 


$28 


-5.38 


0.0001 


1.01 


CNS Infection 




1,615 


170 


9.51 


0.0001 


2.01 


septlcemia/shock 




6,302 


82 


77.28 


0.0001 


3.01 


HIV/AIDS 




4,296 


334 


12.87 


0.0001 


4.01 


bacterial enteritis 




2,869 


191 


15.04 


0.0001 


4.02 


viral enteritis 




17 


151 


0.11 


0.9114 


4.03 


other intestinal infections 




282 


146 


1.94 


0.0526 


4.04 


tuberculosis 




273 


158 


1.73 


0.0846 


4.05 


strep throat/scarlet fever 




-656 


207 


-3.17 


0.0015 


4.06 


other bacterial infections 




1,634 


218 


7.49 


0.0001 


4.07 


bact inf in other diseases 




2,770 


73 


37.86 


0.0001 


4.08 


herpes zoster 




-67 


85 


-0.79 


0.4293 


4.09 


herpes simplex 




317 


157 


2.02 


0.0433 


4.10 


hepatitis 




1,492 


265 


5.63 


0.0001 


4.11 


other viral infections 




-213 


62 


-3.43 


0.0006 


4.12 


late syphilis, symptomatic 




793 


400 


1.98 


0.0475 


4.13 


dermatophytosis 




-354 


35 


-10.03 


0.0001 


4.14 


thrush 




1,730 


194 


8.93 


0.0001 


4.15 


mycoses, miscellaneous 




1,444 


131 


10.99 


0.0001 


4.16 


other infections 




460 


77 


6.20 


0,0001 


5.01 


infection late effects 




902 


277 


3.26 


0.0011 


5.02 


cerebrovasc dis late effects 




773 


77 


10.05 


0.0001 


5.03 


injury late effects 




1,414 


172 


8.23 


0.0001 


6.01 


cancer of mouth/tongue 




1,940 


226 


8.60 


0.0001 


6.02 


cancer of pharynx 




1,357 


283 


4.80 


0.0001 


6.03 


cancer of larynx 




1,155 


234 


4.94 


0.0001 


6.04 


other resp./intrathoracic cancer 




983 


324 


3.03 


0.0024 


7.01 


cancer of esophagus 




3,490 


325 


10.74 


0.0001 


7.02 


cancer of stomach 




3,749 


241 


15.53 


0.0001 


7.03 


cancer of small bowel 




1,945 


274 


7.11 


0.0001 


7.04 


cancer of liver 




1,679 


245 


6.84 


0.0001 


7.05 


cancer of pancreas 




1 3,780 


257 


14.73 


0.0001 


7.06 


other cancer of digestive organs 




1 647 


292 


??? 


0.0265 


8.01 


colon cancer 




1 1,183 


103 


11.53 


0.0001 


9.01 


rectal cancer 




1 1,014 


113 


8.98 


0.0001 


10.01 


lung cancer 




1 1,735 


101 


17.24 


0.0001 


11.01 


breast cancer 




1 -172 


67 


-2.58 


0.0100 


12.01 


lymphoma/Karposi's sarcoma 




1 1,626 


127 


12.79 


0.0001 


12.02 


multiple myeloma 




1 1,305 


219 


5.95 


0.0001 


12.03 


lymphoid leukemia 




1 519 


196 


2.65 


0.0081 



1 

dcg\finaMableh-2\nab 



TABLE H-2 (continued) 

REGRESSION OF 1992 MEDICARE PROGRAM EXPENDITURES ON 1992 HOSPITAL AND PHYSICIAN 
(ALL) DIAGNOSIS DIAGNOSTIC GROUPS 







PARAMETER 


STANDARD 


T FOR HO: 


VARIABLE 


ADDXG 


VARIABLE DF ESTIMATE 


ERROR 


PARAMETER=0 


PROB > ITI 


12.04 


myeloid leukemia 


1 6,153 


317 


19.38 


0.0001 


12.05 


other leukemia 


1 2,473 


244 


10.13 


0.0001 


13.01 


cancer of uterus 


1 584 


168 


3.48 


0.0005 


13.02 


cancer of cervix/female genital 


1 803 


204 


3.94 


0.0001 


14.01 


cancer of placenta/uterine adnexa 


1 1,725 


210 


8.20 


0.0001 


15.01 


prostate cancer 


1 736 


60 


12.24 


0.0001 


15.02 


cancer of testis/male genital 


1 1,210 


363 


3.33 


0.0009 


16.01 


cancer of bladder/urinary organs 1 


549 


96 


5.70 


0.0001 


17.01 


cancer of the eye 1 


78 


393 


0.20 


0.8434 


17.02 


cancer of the brain/nervous system 1 


2,279 


156 


14.64 


0.0001 


17.03 


benign neoplasm brain/nervous 1 


1,128 


180 


6.28 


0.0001 


18.01 


cancer of bone 


1,267 


200 


6.33 


0.0001 


18.02 


cancer of connective tissue 


988 


219 


4.51 


0.0001 


18.03 


melanoma 


147 


181 


0.81 


0.4184 


18.04 


other skin cancer 


45 


SO 


0.90 


0.3669 


18.05 


thyroid/endocrine cancer 


225 


290 


0.77 


0.4389 


18.06 


other/ill-defined site cancer 


896 


84 


10.61 


0.0001 


19.01 


secondary cancer of lymph node 


4,337 


150 


28.89 


0.0001 


19.02 


secondary cancer of respiratory 1 


4,645 


122 


38.14 


0,0001 


19,03 


secondary cancer of other site 1 


3,957 


100 


39.71 


0,0001 


19.04 


disseminated cancer 1 


1,896 


191 


9.95 


0,0001 


20.01 


benign neoplasm of digestive system 1 


-37 


56 


-0.66 


0,5119 


20.02 


benign neoplasm of resp system 1 


218 


196 


1.11 


0,2655 


20.03 


benign neoplasm of skin 1 


-83 


55 


-1.50 


0,1333 


20.04 


benign neoplasm of breast 


-338 


32 


-10.72 


0,0001 


20.05 


benign neoplasm of urinary 


359 


232 


1.55 


0,1221 


20.06 


benign neoplasm of eye 


45 


212 


0.21 


0,8330 


20.07 


other benign neoplasms 1 


271 


64 


4.23 


0,0001 


21.01 


cancer in situ of digestive organs 1 


1,b// 


183 


8.61 


0,0001 


21.02 


cancer in situ of resp system 


489 


244 


2.00 


0,0452 


21.03 


cancer in situ of other sites 


1,076 


107 


10.10 


0,0001 


21.04 


neoplasm of uncertain behavior 


982 


90 


10.85 


0,0001 


21.05 


neoplasm of uncertain behavior 


235 


67 


3.53 


0,0004 


21.06 


unspecified neoplasm 


533 


51 


10.37 


0,0001 


22.01 


diabetes wnthout comp. 1 


66 


29 


2.26 


0,0236 


23.01 


diabetes w/acute comp. 1 


647 


131 


4.96 


0,0001 


24.01 


diatietes with renal manifestation 1 


907 


184 


4.93 


0,0001 


24.02 


diatietes vif/other specified compl. 1 


1,065 


77 


13.89 


0,0001 


24.03 


diabetes w/unspecified compile. 1 


1,463 


61 


23.79 


0,0001 


25.01 


hypoglycemic coma 1 


1,558 


282 


5.52 


0,0001 


25.02 


other hypoglycemia 1 


508 


115 


4.43 


0,0001 


26.01 


disorders of fluid/electrolyte 1 


2.309 


38 


60.68 


0,0001 


27.01 


goiter 1 


239 


113 


2.11 


0,0347 


27.02 


thyrotoxicosis 


1 -98 


95 


-1.03 


0,3023 


27.03 


thyroid disorders 


1 -163 


38 


-4.24 


0,0001 


27.04 


adrenal gland disorders 


1 1,053 


185 


5.70 


0,0001 


27.05 


ovarian dysfunction 


t -62 


171 


-0.36 


0.7165 


27.06 


testicular dysfunction 


1 75 


325 


0.23 


0.8183 


27.07 


other endocrine disorders 


1 -814 


132 


-6.93 


0,0001 


27.08 


misc. endocrine disorders 


1 750 


142 


5.27 


0,0001 


27.09 


protein-calorie malnutrition 


1 5,750 


95 


60.50 


0,0001 


27.10 


vitamin/other nutritional deficiency 


1 -145 


97 


-1.50 


0,1332 


27.11 


disorders of lipoid metabolism 


1 -309 


26 


-11.85 


0.0001 



dcg\final\Tableh-2\nab 



TABLE H-2 (continued) 

REGRESSION OF 1992 MEDICARE PROGRAM EXPENDITURES ON 1992 HOSPITAL AND PHYSICIAN 
(ALL) DIAGNOSIS DIAGNOSTIC GROUPS 







PARAMETER 


STANDARD 


T FOR HO: 


VARIABLE 


ADDXG 


VARIABLE DF ESTIMATE 


ERROR 


PARAMETER=0 


PROB > ITl 


27.12 


disorders of plasma protein met. 


1 448 


176 


2.54 


0.0110 


27.13 


disorders of mineral metatxjjism 


1 1,110 


115 


9.63 


0.0001 


27.14 


metabolism disorders nec/nos 


1 -61 


167 


-0.37 


0.7145 


27.15 


other hyperalimentation 


1 586 


338 


1.73 


0.0829 


27.16 


obesity/localized adiposity 


1 862 


81 


10.64 


0.0001 


28.01 


acute pancreatitis 


1 1,435 


145 


9.87 


0.0001 


28.02 


chronic pancreatitis/other pancr. 


1 1,213 


140 


8.67 


0.0001 


29.01 


end stage liver disorders 


1 4,561 


238 


19.20 


0.0001 


29.02 


esophageal varices 


J 3,642 


329 


11.08 


0.0001 


30.01 


cin-hosis 


1 921 


156 


5.91 


0.0001 


30.02 


other liver disorders 


1 -60 


87 


-0.69 


0.4893 


31.01 


disease of esophagus 


1 55 


46 


1.18 


0.2382 


32.01 


ulcer w/o perforation 


1 358 


53 


6.82 


0.0001 


32.02 


ulcer with perforation 


1 2,844 


234 


12.17 


0.0001 


33.01 


pyloric/duodenal obstruction 


2,390 


261 


9.16 


0.0001 


33.02 


gastritis/oth gastric disorder 1 


149 


29 


5.08 


0.0001 


34.01 


appendicitis 1 


1.555 


249 


6.25 


0.0001 


35.01 


abdominal hernia/complicated 1 


930 


178 


5.22 


0.0001 


36.01 


abdominal hernia/uncomplicated 


28 


45 


0.64 


0.5254 


37.01 


regional enteritis 1 


890 


191 


4.66 


0.0001 


37.02 


idiopathic proctocolitis 


33 


183 


0.18 


0.8567 


38.01 


intestinal obstruction 1 


2,484 


68 


36.34 


0.0001 


38.02 


peritonitis 


7,183 


223 


32.22 


0.0001 


38.03 


other peritoneal disorders 1 


3,043 


182 


16.70 


0.0001 


39.01 


divercula of intestine 


-160 


43 


-3.75 


0.0002 


40.01 


hemon-hoids 1 


-78 


56 


-1.39 


0.1632 


40.02 


anal/rectal disorders 1 


41 


53 


0.76 


0.4455 


40.03 


intestinal abcess, ulceration, 1 


1,941 


126 


15.40 


0.0001 


40.04 


other intestinal disorders 1 


38 


46 


0.83 


0.4092 


41.01 


cholelithiasis 1 


336 


88 


3.82 


0.0001 


41.02 


biliary tract disease 1 


2,984 


175 


17,01 


0.0001 


41.03 


other ganuladder disorders 1 


1,207 


81 


14.94 


0.0001 


42.01 


gastrointestinal hemorrage 


1,103 


50 


22.00 


0.0001 


43.01 


gout/crystal arthropathy 


-308 


65 


-4.78 


0.0001 


43.02 


other arthropathy/joint disorders 1 


90 


26 


3.42 


0.0006 


44.01 


connective tissue disease 1 


8 


101 


0.08 


0,9353 


44.02 


rheumatoid arthritis 


259 


61 


4.22 


0.0001 


44.03 


inflammatory spondylopathies 1 


237 


160 


1.48 


0.1398 


44.04 


polymyalgia rheumatica 1 


-94 


116 


-0.81 


0.4191 


45.01 


arthropathy v\^/infection 1 


1 1,528 


206 


7.42 


0.0001 


45.02 


osteomyelitis 


1 2,272 


124 


18.27 


0.0001 


46.01 


osteoarthrosis 


1 16 


25 


0.64 


0.5211 


47.01 


back disorders 


1 -45 


28 


-1.58 


0.1133 


48.01 


disorders of soft tissue 


1 58 


27 


2.17 


0.0301 


49.01 


osteoporosis 


1 460 


56 


8.22 


0.0001 


49.02 


other bone disorders 


1 364 


52 


7.00 


0.0001 


49.03 


foot disorders 


1 -56 


62 


-0.90 


0.3664 


49.04 


oth acquired limb deformities 


1 1,335 


118 


11.35 


0.0001 


50.01 


anemia 


t 1,031 


33 


31.47 


0.0001 


51.01 


hereditary hemolytic anemias 


1 1,316 


232 


5.68 


0,0001 


51.02 


acquired hemolytic anemia 


1 770 


294 


2.62 


0.0089 


51.03 


aplastic anemia 


1 3,492 


163 


21.39 


0.0001 


51.04 


coagulation defects 


1 603 


92 


6.56 


0.0001 


51.05 


purpura/ throbocytopathy 


1 2,366 


113 


20.99 


0.0001 



dcg\final\Tableh-2\nab 



TABLE H-2 (continued) 

REGRESSION OF 1992 MEDICARE PROGRAM EXPENDITURES ON 1992 HOSPITAL AND PHYSICIAN 
(ALL) DIAGNOSIS DIAGNOSTIC GROUPS 







PARAMETER 


STANDARD 


T FOR HO: 


VARIABLE 


ADDXG 


VARIABLE DF ESTIMATE 


ERROR 


PARAMETER=0 


PROB > ITl 


51.06 


white blood cell disorders 


1 1,444 


103 


13.96 


0.0001 


51.07 


immune disorders 


1 2.607 


269 


9.68 


0.0001 


51.08 


other blood disease 


1 -226 


91 


-2.48 


0.0131 


52.01 


senile/presenile psychoses 


1 -78 


60 


-1.29 


0,1970 


52.02 


other organic psychoses cond. 


1 1,107 


1% 


8.18 


0.0001 


52.03 


cerebral degeneration/Alzheimer's 


1 311 


64 


4,85 


0.0001 


52.04 


senility without psychosis 


1 -399 


198 - 


-2.02 


0.0436 


53.01 


alcoholic psychoses 


1 514 


229 


2.25 


0.0248 


53.02 


dmg psychoses 


1 1,873 


225 


8.31 


0.0001 


54.01 


transient organic mental disorders 


1 2,176 


109 


20.00 


0.0001 


54.02 


hallucinations 


1 709 


262 


2.71 


0.0067 


55.01 


schizophrenic disorders 


1 2,256 


82 


27.51 


0.0001 


56.01 


manic and depressive disorders 


2,242 


67 


33.29 


0.0001 


57.01 


paranoid states 1 


1,531 


246 


6.22 


0.0001 


57.02 


other nonorganic psychoses 1 


435 


65 


6.67 


0.0001 


58.01 


neurotic disorders 


90 


45 


1.97 


0,0486 


59.01 


alcohol dependence 


1,553 


137 


11.36 


0.0001 


59.02 


drug dependence 1 


3,363 


238 


14.15 


0.0001 


59.03 


non-dependent abuse of drugs 1 


922 


99 


9.36 


00001 


60.01 


personality disorders 1 


2,752 


165 


16.68 


0.0001 


60.02 


sexual disorders 


-224 


192 


-1.16 


0.2456 


60.03 


psychophysiologic disorders 


-172 


236 


-0.73 


0.4654 


60.04 


acute reaction to stress 


-289 


174 


-1.66 


0.0973 


60.05 


adjustment reaction 1 


2,206 


114 


19.39 


0.0001 


60.06 


nonpsychotic brain syndrome 1 


-117 


81 


-1.44 


0.1493 


60.07 


other depression 


574 


64 


9.00 


0.0001 


60.08 


behavior disorder 1 


1,082 


270 


4.00 


0.0001 


60.09 


developmental/behavioral disord. 1 


892 


244 


3.66 


0.0003 


60.10 


mental retardation 1 


-439 


123 


-3.58 


0.0003 


60.11 


other mental disorders 1 


159 


154 


1.03 


0.3027 


61.01 


headaches 1 


42 


46 


0.91 


0.3637 


62.01 


parkinsc 's disease 1 


166 


77 


2.15 


0.0313 


62.02 


extrapyramidal disease 1 


422 


118 


3.57 


0.0004 


62.03 


anterior horn cell disease 1 


1,289 


330 


3.91 


0.0001 


62.04 


other spinal cord disease 1 


2,892 


213 


13.55 


0.0001 


62.05 


autonomic nerve disorder 1 


1,448 


189 


7.67 


0.0001 


62.06 


other CNS diseases 1 


110 


272 


0.41 


0.6858 


63.01 


MS, other CNS dymelination 1 


945 


177 


5.34 


0.0001 


63.02 


infantile cerebral palsy 1 


205 


229 


0.89 


0.3711 


63.03 


quadriplegia 1 


3,931 


282 


13.96 


0.0001 


63.04 


paraplegia 1 


3,478 


243 


14.33 


0.0001 


63.05 


Cauda equina syndrome 1 


1,135 


124 


9.13 


0.0001 


63.06 


other paralytic disorders 1 


1,873 


200 


9.36 


0.0001 


63.07 


nervous/musculoskeletal system 1 


857 


72 


11.87 


0.0001 


63.08 


other central nervous system dis. 1 


1,263 


?no 


6.30 


0.0001 


64.01 


seizure disorders 


730 


60 


12.17 


0.0001 


65.01 


trigeminal nerve disorder 1 


136 


191 


0.71 


0.4753 


65.02 


facial nerve disorders 1 


-51 


177 


-0.29 


0.7754 


65.03 


root/plexus disorders 1 


186 


284 


0.66 


0.5115 


65.04 


root/plexus lesions 1 


819 


297 


2.76 


0.0058 


65.05 


other cranial nerve disorders 1 


457 


392 


1.17 


0.2427 


65.06 


neuropathy of upper limb 1 


188 


89 


2.12 


0.0339 


65.07 


neuropathy of leg 1 


-82 


89 


-0.93 


0.3548 


66.01 


peripheral neuropathy 


26 


97 


0.27 


0.7862 



clcg\final\Tableh-2\nab 



TABLE H-2 (continued) 

REGRESSION OF 1992 MEDICARE PROGRAM EXPENDITURES ON 1992 HOSPITAL AND PHYSICIAN 
(ALL) DIAGNOSIS DIAGNOSTIC GROUPS 







PARAMETER 


STANDARD 


T FOR HO: 


VARIABLE 


ADDXG 


VARIABLE DF ESTIMATE 


ERROR 


PARAMETER=0 


PROB > ITI 


66.02 


inflammatory/loxic neuropathy 


1 1,497 


133 


11.25 


0.0001 


66.03 


myoneural disorders 


1 758 


285 


2.66 


0.0079 


66.04 


muscular dystrophies 


1 2,274 


250 


9.10 


0.0001 


66.05 


other neuropathy 


I 153 


%1 


0.61 


0.5419 


67.01 


other brain disorders 


1 2,815 


100 


28.23 


0.0001 


68.01 


rheumatic fever/heart disease 


1 462 


119 


3.89 


0.0001 


68.02 


mitral or aortic valve disease 


1 649 


45 


14.43 


0.0001 


68.03 


mitral/aortic valve disorders 


1 1,286 


92 


13.98 


0.0001 


69.01 


essential hypertension 


1 93 


19 


4.77 


0.0001 


69.02 


hypertensive heart disease 


1 91 


45 


2.01 


0.0444 


70.01 


malignant hypertension 


45 


54 


0.82 


0.4120 


70.02 


malignant hypertensive heart dis. 1 


299 


132 


2.27 


0.0230 


70.03 


hycertensive heart and renal dis. 1 


709 


121 


5.86 


0.0001 


70.04 


secondary hypertension 1 


3W> 


269 


1.34 


0.1817 


70.05 


hypertension encephalopathy 1 


888 


211 


4.20 


0.0001 


71.01 


myocardial infarction 1 


1,445 


76 


18.91 


0.0001 


71.02 


old myocardial infarction 1 


731 


72 


10.11 


0.0001 


71.03 


other chronic ischemic heart dis. 1 


116 


26 


4.42 


0.0001 


72.01 


acute myocardial infarction 1 


4,551 


96 


47.55 


0.0001 


73.01 


other acute ischemia 1 


3,507 


56 


62.18 


0.0001 


74.01 


angina pectoris 1 


461 


40 


11.67 


0,0001 


75.01 


pulmonary embolism 


1,970 


130 


15.19 


0.0001 


75.02 


other pulmonary heart disease 


1,908 


95 


20.10 


0.0001 


76.01 


conduction dis./cardiac dysrhyth. 1 


320 


34 


9.47 


0,0001 


76.02 


premature heart beats 1 


155 


65 


2.39 


0,0167 


77.01 


atrial arrythmia 1 


1,066 


40 


26.96 


0,0001 


78.01 


ventric tachycardia 


2,741 


106 


25.83 


0,0001 


79.01 


heart arrest/shock 1 


4,470 


100 


44.74 


0.0001 


80.01 


heart failure 1 


653 


34 


19.30 


0,0001 


81.01 


pericarditis, post-MI 1 


2,800 


146 


19.22 


0,0001 


81.02 


acute endo/myocarditis 1 


2,739 


276 


9.94 


0,0001 


81.03 


cardiomyopathy/myocarditis 1 


1,053 


72 


14.70 


0,0001 


81.04 


cardiomegaly 1 


932 


51 


18.17 


0.0001 


81.05 


other heart disease 1 


658 


66 


9.98 


0.0001 


82.01 


cerebral hemorrhage 


2,970 


121 


24.62 


0.0001 


83.01 


preceretiral arterial occlusion 


738 


59 


12.54 


0,0001 


84.01 


cerebrovascular disease (stroke) 


930 


43 


21.41 


0.0001 


84.02 


hemiplegia 


4,398 


97 


45.19 


0.0001 


84.03 


aphasia 1 


2,513 


159 


15.80 


0.0001 


85.01 


transient cerebral ischemia 1 


101 


56 


1.80 


0.0727 


86.01 


atherosclerosis of major vessel 1 


•450 


54 


8.26 


0.0001 


86.02 


atherosclerosis/general, ascvd 1 


214 


38 


5.61 


0.0001 


87.01 


aortic aneurysm 


1,316 


90 


14.59 


0,0001 


87.02 


other aneurysm 


2,987 


172 


17.36 


0.0001 


88.01 


arterial emtwlism and thrombosis 


2,800 


98 


28,45 


0.0001 


89.01 


specified peripheral vascular dis. 1 


1,269 


132 


9.59 


0.0001 


89.02 


Raynaud's syndrome 


321 


733 


1.37 


0.1693 


89.03 


peripheral vascular disease 


1 75 


46 


1.64 


0.1017 


89.04 


other arterial disease 


1 1,345 


90 


14.87 


0.0001 


89.05 


disease of capillaries 


1 245 


236 


1.04 


0,2982 


89.06 


vascular insufficiency of intestine 


1 4.127 


194 


21.28 


0,0001 


89.07 


gangrene 


! 7,140 


142 


50.40 


0.0001 


90.01 


thrombophlebitis 


\ 1.382 


66 


20.99 


0,0001 


90.02 


noninfectious lymphatic disorders 


1 401 


186 


2.15 


0.0313 



dcg\finaMableh-2\nab 



TABLE H-2 (continued) 

REGRESSION OF 1992 MEDICARE PROGRAM EXPENDITURES ON 1992 HOSPITAL AND PHYSICIAN 
(ALL) DIAGNOSIS DIAGNOSTIC GROUPS 







PARAMETER 


STANDARD 


T FOR HO: 


VARIABLE 


ADDXG 


VARIABLE OF ESTIMATE 


ERROR 


PARAMETER=0 


PROB > ITI 


90.03 


hemorrhage nos 


1 3,083 


220 


14.04 


0,0001 


90.04 


compression of vein 


1 843 


239 


3.54 


0,0004 


91.01 


hypotension 


1 1.509 


84 


17.91 


0.0001 


92.01 


superficial phlebltls-leg 


t 172 


165 


1.04 


0.2977 


92.02 


varicose veins 


1 186 


77 


2.43 


0.0151 


92.03 


other circulatory disease 


t 910 


98 


9.27 


0,0001 


92.04 


oth specified circulatory disorders 


i 284 


B2 - 


3.47 


0,0005 


93,01 


diabetic retinopathy 


1 116 


79 


1.47 


0,1415 


93.02 


proliferative diabetic retinopathy 


1 246 


174 


1.41 


0,1582 


93.03 


endophthalmitis 


1 206 


314 


0.65 


0,5133 


93.04 


retinal disorders 


1 -49 


33 


-1.49 


0,1363 


93.05 


glaucoma 


64 


32 


1.99 


0.0463 


93.06 


cataract/lens replacement 





21 


-0.01 


0.9895 


93.07 


disorders of refraction and accommodation 


-122 


49 


-2.49 


0.0127 


93.08 


vitreous hemorrhage 1 


855 


195 


4.39 


0.0001 


93.09 


other eye disorders 1 


16 


24 


0.65 


0,5144 


94.01 


impacted cerumen 


-221 


45 


-4,88 


0.0001 


94.02 


Otis media 


8 


58 


0.14 


0,8857 


94.03 


vertiginous syndromes 1 


-215 


69 


-3.12 


0.0018 


94.04 


hearing loss 1 


43 


57 


0.75 


0.4527 


94.05 


other ear disorders 1 


-19 


53 


-0,37 


0,7152 


95.01 


aojte nose/throat infection 1 


-342 


29 


-11,81 


0,0001 


95.02 


nasal polyps/allergic rhinitis 


-170 


49 


-3,44 


0,0006 


95.03 


chronic sinusitis 1 


-183- 


52 


-3.51 


0,0004 


95.04 


larynx/vocal cord diseases 1 


957 


158 


6.07 


0,0001 


95.05 


paralysis of vocal cords/larnyx 


4,117 


314 


13,09 


0.0001 


95,06 


disorders of teeth and jaw 


231 


101 


2,30 


0.0217 


95,07 


other diseases of upper respir. 1 


-60 


67 


-0,90 


0.3686 


95,03 


salivary gland diseases 


462 


168 


2,74 


0.0061 


95,09 


oral soft tissue/tongue/jaw dis. 


-140 


105 


-1,33 


0.1849 


96.01 


emphysema/chronic bronchitis 1 


448 


30 


14,73 


0.0001 


97.01 


other bronchitis 


-361 


30 


-12,07 


0.0001 


98.01 


viral pneumonia 


946 


149 


6,37 


0.0001 


98.02 


influenza 


-268 


80 


-3,34 


0,0008 


99.01 


gram-neg./staph pneumonia 1 


7,281 


129 


56,30 


0,0001 


100.01 


specific tjaclerial pneumonia 1 


903 


122 


7.44 


0,0001 


100.02 


other pneumonia 1 


1.087 


43 


25.23 


0,0001 


101.01 


asthma 1 


3^ 


SO 


7.31 


0,0001 


102.01 


bronchiectasis, external agent 1 


102 


130 


0,79 


0,4311 


102.02 


aspiration pneumonia 


6,086 


137 


44.51 


0,0001 


102.03 


resp cond (ext agent) 1 


305 


87 


3.50 


0,0005 


103.01 


pleurisy/pneumothorax 1 


3,501 


61 


57.41 


0,0001 


104.01 


empyema/abscess 


4,382 


251 


17.48 


0,0001 


104.02 


pulmonary congest/hypostasis 1 


1,138 


70 


16.31 


0,0001 


104.03 


acute lung edema nos 1 


2,758 


141 


19.59 


0.0001 


104.04 


post trauma pulmonary insufficiency 1 


12,919 


182 


71.04 


0.0001 


104.05 


other lung disease 1 


2,273 


48 


47.05 


0,0001 


105,01 


respiratory failure 1 


3.509 


55 


63.60 


0.0001 


105.02 


respiratory arrest 


12,688 


133 


95,28 


0,0001 


106.01 


nephritis 


1 844 


143 


5,88 


0,0001 


106.02 


acute renal failure 


1 7,066 


129 


54,79 


0,0001 


106.03 


chronic renal failure 


1 1,613 


108 


15,00 


0,0001 


106.04 


renal failure unspecified 


1 405 


107 


3,80 


0,0001 


106.05 


impaired renal function 


t -494 


191 


-2,59 


0,0097 



(jcg\final\T3bleh-2\r.ai) 



TABLE H-2 (continued) 

REGRESSION OF 1992 MEDICARE PROGRAM EXPENDITURES ON 1992 HOSPITAL AND PHYSICIAN 
(ALL) DIAGNOSIS DIAGNOSTIC GROUPS 



ADDXG 


VARIABLE 


107.01 


kidney infection 


108.01 


renal/ureteral/t)!adder calculus 


109.01 


urethral stricture 


109.02 


hydronephrosis/other renal/dis. 


110.01 


other urinary tract infections 


111.01 


other urinary disorders 


112.01 


hyperplasia of prostate 


112.02 


other prostatic disorders 


112.03 


penis/testis/male gen disorders 


113.01 


diseases of female pelvic organs 


113.02 


vaginal and cervical diseases 


113.03 


other diseases of female genitals 


113.04 


female stress incontinence 


113.05 


menopausal and postmenopausal 


114.01 


genital prolapse 


115.01 


pregnancy/birth complications 


115.02 


abortion 


115.03 


normal pregnancy/delivery 


116.01 


dermatologicai disorders 


116.02 


bullous dermatoses 


117.01 


chronic ulcer of skin 


118.01 


dermatitis due to internal agents 


118.02 


psori^i.sts and similar disorders 


118.03 


other dermatosis 


118.04 


diseases of nail 


118,05 


other dermatologicai disorders 


119.01 


congenital anomalies of nervous 


119.02 


congenital anomalies of eye 


119.03 


congenital anomalies of cardiac 


119.04 


congenital anomalies of muscul. 


119.05 


congenital anomalies of skin 


119.06 


chromosomal anomalies 


119.07 


other congenital anomalies 


120.01 


somatic/segmental dysfunction 


120.02 


dizziness and giddiness 


120.03 


malaise and fatigue 


120.04 


other general symptom 


121.01 


coma 


121.02 


syncope and collapse 


122.01 


fever 


123.01 


dyspnea/other resp abnormalities 


123.02 


hemoptysis 


123.03 


cough 


123.04 


respiratory/other chest symptoms 


124.01 


chest pain 


124.02 


other cardiovascular symptoms 


125.01 


retention of urine 


125.02 


incontinence/urethral discharge 


125.03 


other urinary system symptoms 


125.04 


abdominal/pelvis symptoms 


126.01 


vertebral fracture w/o spinal fract. 


126.02 


vertebral fracture with spinal fract 


127.01 


fractures of skull/face 


127.02 


fractures of nasal bone 



PARAMETER 


STANDARD 


T FOR HO: 


VARIABLE 


DF ESTIMATE 


ERROR 


PARAMETER=0 


PROB > IT! 


1 -823 


113 


-7.27 


0.0001 


1 398 


88 


4.52 


0.0001 


1 88 


96 


0.91 


0.3609 


1 270 


61 


441 


0.0001 


1 380 


29 


13.00 


0.0001 


1 301 


47 


6.45 


0.0001 


1 25 


39 


0.66 


0.5119 


1 -119 


61 


-1.94 


0.0522 


1 44 


80 


0.56 


0.5792 


1 730 


106 


6.88 


0.0001 


1 -26 


59 


-0.44 


0,6627 


1 -10 


75 


-0.14 


0.8920 


1 207 


117 


1.77 


0,0769 


1 -55 


47 


-1.19 


0,2357 


1 151 


85 


1.78 


0.0758 


1 919 


117 


7.88 


0,0001 


1 868 


548 


1.^ 


0.1130 


1 5 


379 


0.01 


0,9885 


1 246 


38 


6.47 


0,0001 


1 344 


269 


1.28 


0,2018 


1 1,715 


56 


30.70 


0,0001 


1 1,312 


177 


7.40 


0,0001 


1 -5 


102 


-0.05 


0,9593 


1 -121 


36 


-3.38 


0,0007 


1 -128 


40 


-3.18 


0,0015 


1 -207 


27 


-7.55 


0,0001 


1 70 


209 


0.33 


0,7397 


1 411 


153 


2.70 


0,0070 


1 1,189 


81 


14.63 


0,0001 


1 769 


98 


7.88 


0,0001 


1 -95 


136 


-0.70 


0,4851 


1 -62 


268 


-0.23 


0,8179 


1 330 


91 


3.63 


0,0003 


1 48 


70 


0.69 


0,4921 


1 -265 


42 


-6.34 


0,0001 


1 -221 


39 


-5.61 


0,0001 


1 165 


24 


6.84 


0,0001 


1 2,717 


132 


20.52 


0,0001 


1 282 


54 


5.18 


0,0001 


1 1.295 


66 


19.66 


0,0001 


1 931 


35 


26.66 


0,0001 


1 -60 


138 


-0.44 


0,6624 


1 -42S 


46 


-9.31 


0,0001 


1 514 


44 


11.62 


0,0001 


1 380 


27 


1402 


0,0001 


1 31 


47 


0.66 


0,5115 


1 1,813 


77 


23.65 


0,0001 


1 235 


78 


3.01 


0,0026 


1 -292 


49 


-5.91 


0,0001 


1 120 


30 


3.97 


0,0001 


1 646 


99 


6.52 


0,0001 


1 1.715 


290 


5.91 


0,0001 


1 1,560 


192 


8.13 


0,0001 


1 -695 


258 


-2.70 


0,0070 



dcg\final\Ta&leh-2\nab 



TABLE H-2 (continued) 

REGRESSION OF 1992 MEDICARE PROGRAM EXPENDITURES ON 1992 HOSPITAL AND PHYSICIAN 
(ALL) DIAGNOSIS DIAGNOSTIC GROUPS 







PARAMETER 


STANDARD 


T FOR HO: 


VARIABLE 


ADDXG 


VARIABLE OF ESTIMATE 


ERROR 


PARAMETER=0 


PROB > ITI 


128.01 


pelvic fracture 


1 1.415 


145 


9.79 


0,0001 


129.01 


femoral fracture 


1 3,899 


73 


53.49 


0,0001 


130.01 


fractures of lower limb 


1 288 


80 


3.59 


0,0003 


131.01 


shoulder dislocation 


1 539 


239 


2.26 


0,0241 


131.02 


dislocation of hip 


1 3.526 


341 


10.34 


0,0001 


131.03 


disJocation of knee 


1 797 


140 


5.71 


0,0001 


131.04 


other dislocations 


1 -22 


57 


-0.40 


0,6909 


131.05 


fracture of rib, closed 


1 -257 


104 


-2.46 


C,0138 


131.06 


hand/wrist/lower arm fracture 


1 226 


82 


2.75 


0,0059 


131.07 


other fractures 


1 470 


77 


6.10 


0,0001 


132.01 


foreign body in pharnyx/larnyx 


1 821 


148 


5.55 


0,0001 


132.02 


heart/lung/blood vessels injury 1 


1 1.969 


222 


8.88 


0,0001 


132.03 


gi/liver/kidney/spleen/pelvis 


1.806 


223 


8.09 


0,0001 


132.04 


open wound of eye 


133 


241 


0.55 


0,5316 


132.05 


open wound/injury of lower arm 1 


-482 


64 


-7.55 


0,0001 


132.06 


open wound of other sites 


232 


59 


3,91 


0.0001 


132,07 


amputation of limb/hand/foot/toe 1 


4,516 


200 


22.61 


0,0001 


132.08 


crushing injury 


-211 


292 


-0.72 


0,4698 


132.09 


foreign body in eye/ear/nose 1 


-80 


146 


-0.55 


0,5841 


133.01 


sprains 1 


-126 


39 


-3.21 


0,0013 


134.01 


concussion 1 


-153 


207 


-0.74 


0,4603 


134.02 


contusion/superficial injury 1 


-167 


36 


-4.70 


0,0001 


134.03 


accidental falls 1 


998 


75 


13.29 


0,0001 


134.04 


suicide/self-inflicted injury 


3,485 


447 


7.80 


0,0001 


134.05 


other accidents 


306 


86 


3.54 


0,0004 


135.01 


intracranial injury 


1,265 


105 


12.07 


0,0001 


136.01 


third degree burns 1 


5,766 


447 


12.89 


0,0001 


136.02 


other burns 1 


688 


165 


4.16 


0,0001 


136.03 


nerve injury 


1,053 


168 


6.28 


0,0001 


136.04 


early complications of trauma 


3,297 


205 


16.05 


0.0001 


137.01 


poison effects 1 


485 


111 


4.38 


0.0001 


137.02 


toxic effects, named substance 


308 


131 


2.35 


0,0186 


137.03 


toxic effects of other nonmedicinal 1 


-367 


171 


-2.15 


0,0316 


137.04 


allergy, unspecified 


-213 


102 


-2.09 


0,0371 


137.05 


adverse effects of drugs 1 


306 


65 


4.70 


0,0001 


138.01 


malfunction of internal orlhop. dev. 1 


2,375 


179 


13.M 


0,0001 


138.02 


infection due to int. graft/device 1 


5,981 


174 


34.38 


0,0001 


138.03 


other complications of med. procedures 1 


4,246 


90 


47.18 


0,0001 


138.04 


other compl. of medical care 1 


6,013 


60 


100.32 


0,0001 


138.05 


misadventure to patient in surgery 


1,953 


206 


9.47 


0,0001 


139.01 


kidney/heart/lung/liver transplant 


5,644 


317 


17.82 


0.0001 


139.02 


other organ transplant 1 


934 


239 


3.90 


0,0001 


139.03 


heart/valve replacement 1 


2,057 


152 


13.50 


0,0001 


139.04 


joint replacement 1 


4,642 


98 


47.21 


0.0001 


139.05 


other organ replacement 1 


3,306 


353 


9.37 


0,0001 


139.06 


artificial opening status/attention 1 


4,136 


117 


35.44 


0,0001 


139.07 


postsurgical states, eye 1 


2,368 


414 


5,72 


0,0001 


139.08 


other postsurgical states "• 


1 2,585 


54 


48.07 


0,0001 


139.09 


machine dependence 


1 32,792 


418 


78.46 


0,0001 


140.01 


rehabilitation procedures 


1 5,348 


73 


72.77 


0,0001 


141.01 


radiotherapy 


1 2,385 


119 


19.96 


0,0001 


142.01 


chemotherapy 


1 2,634 


135 


19.46 


0,0001 


143.01 


infectious Jisease contact/carrier 


1 -41 


275 


-0.15 


0,8812 


143.02 


preventive 


1 -229 


38 


-6.10 


0,0001 



8 

dcg\final\Tableh-2\nab 



TABLE H-2 (continued) 

REGRESSION OF 1992 MEDICARE PROGRAM EXPENDITURES ON 1992 HOSPITAL AND PHYSICIAN 
(ALL) DIAGNOSIS DIAGNOSTIC GROUPS 







PARAMETER 


STANDARD 


T FOR HO: 


VARIABLE 


ADDXG 


VARIABLE DF ESTIMATE 


ERROR 


PARAMETER=0 


PROS > IT| 


143.03 


history of malignant neoplasm 


1 89 


54 


1.65 


0.0984 


143.04 


tiistory of mental dis/oth disease 


1 392 


87 


4.49 


0.0001 


143.05 


history of drug allergy 


1 701 


88 


7.95 


0.0001 


143.06 


family history of disease 


1 -266 


104 


-2.56 


0.0105 


143.07 


problems of int. organs/ext. sites 


1 697 


204 


3.42 


0.0006 


143.08 


elective surgery 


1 726 


397 


1.83 


0.0678 


143.09 


prothesis/other device fitting 


1 81 


160 


0.51 


0.6109 


143.10 


other orthopedic aftercare 


1 1,274 


148 


8.62 


0.0001 


143.11 


aftercare 


1 1 ,788 


91 


19.59 


0.0001 


143.12 


donor 


1 6,361 


387 


16.44 


0.0001 


143.13 


family/other pyschosocial circum. 


994 


309 


3.21 


0.0013 


143.14 


care not delivered 


1,166 


169 


6.92 


0.0001 


143.15 


aJministrative/consultation 


183 


123 


1.49 


0.1362 


143.16 


screening for malignant neoplasm 1 


-274 


46 


-5.93 


0.0001 


143.17 


screening/obser/ation/special exam 1 
AGE/SEX 


253 


21 


12.20 


0.0001 




FEMALE, < 65 1 


-71 


55 


-1.30 


0.1923 




FEMALE, 70-74 1 


-55 


33 


-1.67 


0.0941 




FEMALE, 75-79 1 


-114 


35 


-3.21 


0.0013 




FEMALE, 80-84 1 


-237 


40 


-5.94 


0.0001 




FEMALE, 85 OR OLDER 1 


-514 


43 


-12.01 


0.0001 




MALE, < 65 1 


-232 


47 


-4.98 


0.0001 




MALE, 65-69 1 


-24 


38 


-0.62 


0.5334 




MALE, 70-74 1 


-73 


38 


-1.91 


0.0563 




MALE, 75-79 1 


-194 


42 


-4.59 


0.0001 




MALE, 80-84 1 


-430 


51 


-8.43 


0.0001 




MALE, 85 OR OLDER 1 


-552 


62 


-8.97 


0.0001 



SOURCE 1992 Medicare claims 



9 

dcg\final\Tableh-2\nab 



TABLE H-3 

CONCURRENT HIERARCHICAL COEXISTING CONDITIONS (HCCs) 



HOSPITAL AND PHYSICIAN DIAGNOSES 



Coneuirent 
ADDCO' 



HCC 

Hierarchy 



Status for 
Models 



Hierarchy Rule 



Payment 



Classification 



SepticemlayShock 

2.01 septicemia/shock 

Moderate Cost Infectious Diseases 



20 



3.01 


HIV/AIDS (including pneumocytosis) 


5 


(8) 


4.07 


bacterial infection in other diseases 


8 


(12) 


Other Infectious Disease 






1.01 


central nervous system infection (e.g . meningitis) 




(2) 


4.02 


viral enteritis (intestinal infections) 






4.03 


other intestinal infections 






4.04 


tuberculosis 






405 


strep throaUscarlet fever 






4.06 


other t>actenal infections 






4.08 


herpes zoster (shingles) 






409 


herpes simplex 






4.10 


viral hepatitis 






4.11 


other viral infections 






412 


late.syphilis. symptomatic 






4.13 


dermatophytosis (fungal skin infections. 
e.g.. athlete's foot) 






4.14 


thrush 






4.15 


mycoses (fungal diseases), miscellaneous 






4.18 


other infections 






5.01 


infection late effects 




(3) 



Metastatic Cancer 

19.01 secondary cancer of lymph node 

19.02 secondary cancer of respiratory and digestive 
systems 

1 9.03 secondary cancer of other site 

19.04 disseminated cancer 

High Cost Cancers 

7.01 cancer of esophagus 

7.02 cancer of stomach 

7.03 cancer of small bowel/pentoneum 

7.04 cancer of liver 

7 05 cancer of pancreas 

10.01 lung cancer 

12.04 myeloid leukemia 

1 7.02 cancer of the brain/nervous system/pituitary, 
pineal glands 

Moderate Cost Cancers 

6.01 cancer of mouth/tongue 

6.02 cancer of pharynx 
6-03 cancer of larynx 

6.04 other respiratory/intra thoracic cancer 

S.01 colon cancer 

9.01 Tcctai cancer 

12.01 lymphoma/Karposi's sarcoma/Hodg kin's Disease 

12.02 muttiple TTiyeloma 

12.03 lymphoid leukemia 

1 2.05 other leukemia 

1 4.01 cancer of ovaries/placenta/utehne adnexia 

15.02 cancer of testis/male genital organs 

18.01 cancer of bone and arbcular cartilage 

18.02 cancer of connective and other soft tissue 

Lower Cost Cancers 

7.06 

11.01 
13.01 
13.02 
15.01 
16.01 
17.01 
18.03 
18.05 
18.06 



other, unspecified cancer of digestive organs/ 

peritonium 

breast cancer 

cancer of utenjs 

cancer of cennx/female genital organs 

prostate cancer 

cancer of biadder/Kidney/urinary organs 

cancer of the eye 

melanoma 

thyroid/endocrine cancer 

other/ill-deflned site cancer 



Carcinoma In Situ 

21.01 carcinoma in situ of digestive organs 

21 .02 carcinoma in situ of respiratory system 

21.03 carcinoma in situ of other sites 

Uncertain Neoplasm 

21.04 neoplasm of uncertain tjehavior. specified sites 

21 .05 neoplasm of uncertain behavior nec/nos 

21.06 unspecified neoplasm 



None 



None 



None 



Out 



Out 



1 


(3) 


14 


(20) 


20 




10 


(3) 


3 




2 


(5) 


5 


(8) 


3 


(5) 


5 


(12) 


14 


(12) 


3 


(8) 


10 


(12) 


3 


(8) 



Neoplasm 



Neoplasm If in HCC 4 cannot be in HCC 5. 



Neoplasm If in HCC 4 or 5 cannot be in 



1 


(3) 




HCC 6, 


3 








1 








3 








1 
1 
1 


(3) 
(2) 






3 








3 








1 


(2) 






3 


W 






3 








1 


(2) 










Neoplasm 


If in HCC 4, 5. or 6, then cannot 


1 






be in HCC 7. 


1 








1 








1 
1 


(3) 






1 








1 








1 








1 








3 












Neoplasm 


If in HCC 4-7. then 


4 


(5) 




cannot be in HCC 8. 


10 


(8) 






3 


(4) 










Neoplasm 


If in HCC 4 - 8, then cannot be 


3 






in HCC 9. 


1 








1 









Out 



cicg\fir3;lTabieri-3\dfnt) 



TABLE H-3 

CONCURREMT HIERARCHICAL COEXISTING CONDmONS (HCCs) 



10 Skin Cancer, except Melanoma 

18.04 skin cancer, except melanoma, including tip 

11 Benign Neoplasm, Except Breast 

17.03 benign neoplasm brain/nervous system/pituitary, 
pineal glands 

20.01 l>enign neoplasm of digestive system 

20.02 benign neoplasm of respiratory system 

20.03 benign neoplasm of skin 

20.05 benign neoplasm of urinary tract 

20.06 benign neoplasm of eye 

20.07 other benign neoplasms 

12 Benign Naoplasm of Breast/Other Breast Disorders 

20.04 benign neoplasm of breast/other breast disorders 

13 Diabetes With Complications 

23,01 dlatjeles with acute complications 

24.01 diabetes wiIjT renal manifestation 

24.02 diabetes wvith other specified complications 
24 03 diabetes with unspecified complications 

25.01 hypoglycemic coma 

93.02 pre ..ative diabetic retinopathy 

14 Diabetes Without Complications 
22.01 diatwtes without complications 
93.01 diabetic retinopathy 

15 Protein -Calorie Malnutrition 

27.09 protein-caiorie malnutrition 

ie Other Higher Cost Endocrine, Metabolic, Nutritional 
Disorders 

26.01 disorders of fluid/etectrolyte/acid-base balance 

27 04 adrenal gland disorders, e g . Cushing's syndrome 

27.12 disorders of plasma protein metabolism 

17 Other Lower Cost Endocrine. Metabolic, Nutritional 
Disorders 

25.02 other hypoglycemia 

27.01 goiter 

27.02 thyrotoxicosis, including Graves' disease 

27.03 thyroid disorders 
27 05 ovanan dysfunction 

27.06 testicular dysfunction 

27.07 other endocnne disorders 

27 08 prtuitary/parathyroid/thymus/polyglandular disorders 

27.10 vjtamin/other nutr'*(onal deficiencies 
{eg. rickets, scurvey) 

27.13 disorders of mineral metabolism 
27 14 metabolism disorders, nec/nos 

27.15 other hyperalimentation 

27.16 obesjty/localized adiposity 

1B Higfi Cholesterol 

27 11 disorders of lipoid metabolism {high cholesterol) 

iS Liver Disease 

29.01 end stage Irver disorders 

29.02 esophageal varices 

20 Cirrtiosis 

30.01 cirrhosis 

21 Peritonitis 

38.02 peritonitis 

22 High Cost Gastrointestinal Disorders 

4.01 bactenal enteritis (intestinal infections) 

23.01 acute pancreatitis 

33.01 pyloric/duodenal obstruction 

38.01 intestinal obstruction 

38.03 other peritoneal disorders 

41 .02 biliary tract disease 

23 Moderate Cost Gastrointe'^tinal Disorders 

32.02 ulcer with p€fforation 

34,01 appendicitis 

35 01 abdominal hernia, complicated 

40.03 intestinal abscess/uiceration/perforation 
41 01 cholelithiasis (gallstones) 

41 .03 other gallbladder disorders 



Concurre 


nt 


HCC 
HIararchv 


Hierarchy Rule 


Status for 
Models 


ADDCO 


Pavment Classirtcation 


1 




Neoplasm 


If in HCC 4 . 9, then 
cannot be in HCC 10 


Out Out 


3 


(1) 


Neoplasm 


If in HCC 4- 10, then cannot 
tie in HCC 11. 


Out Cut 


1 
3 

1 










3 

1 
1 


(■») 









(5) 
(2) 



14 (20) 



14 (12) 
6 (12) 



Neop'asm 



DIatietes 



If in HCC 4-1 1 . cannot be in 
HCC 12. 



Diabetes 



None 



If in HCC 13. f-.en cannot be 
in HCC 14 



Out 



Out 



If in HCC 19. cannot be in HCC 20 



7 




Gastrointestinal 








Gastrointestinal 


If in HCC 21 then cannot be in 


5 


(8) 




HCC 22 


5 


(8) 






8 








8 








B 


(12) 






8 


(12) 










Gastrointestinal 


If in HCC 21 or 22, cannot be 


1 


(3) 




HCC 23 


3 


(S) 






3 








3 








3 


(1) 






3 


(1) 







acg'-firaMati-fi-a^dT^b 



TABLE H-3 

CONCURRENT HIERARCHICAL COEXISTING CONDfTlONS (HCCs) 



HCC 

24 Other 
2802 

30.02 
31.01 
32.01 
33.02 
36,01 
37.01 
37.02 
39.01 
40.01 
40.02 
40.04 
42.01 



Gastrointestinal Disorders 

chronic pancreatitis/other pancreatic disease/ 

intestinal malabsorption 

other liver disorders 

disease of esophagus 

ulcer without perforation 

gastntis/other gastric disorder (stomach disorders) 

abdominal hemia/uncomplicated 

regional enteritis (Crohn's disease) 

ulcerative colitis 

divercula of intestine 

hemorrhoids 

anal/rectal disorders 

other intestinal disorders 

gastrointestinal hemon-hage 



25 Bone and Joint Infections 

45.01 arthropathy with infection 

45.02 osteomyelitis 

26 Rheumatoid Arthritis and Connective Tissue Disease 

44.01 systemic lupus erythematosus and other 
con-iactive tissue disease 

44.02 rheumatoid arthritis and 

other inflammatory polyarthropathy 

27 Other IVlusculoskeletal and Connective Tissue Disorders 
43 01 gout/crystal arthropathy 

43.02 other a rthropa thy/joint disorders 

44.03 inflammatory spondylopathies 

44.04 polymyalgia rheumatica 
46,01 osteoarthrosis 

47 01 back disorders 

48.01 disorders of soft tissue (eg. tendonitis, bursitis) 

49.01 osteoporosis 

49.02 other bone disorders (eg . curvature of spine. 
Pagets disease) 

49.03 flat foot, acquired deformities of toe 

49.04 other acquired limb deformities 

1 1 9 04 congenital anomalies of musculoskeletal/Iimb 

28 Aplastic Anemia 

51 .03 aplastic anemia 

29 Blood/Immune Disorders 

51 01 sickle cell and other hereditary hemolytic anemias 

51.02 acquired hemolytic anemia 

51.04 hemophilia and other coagulation defects 

51.05 purpuraAhromb'.-^topathy/hemorrhagic conditions 

51 .06 white blood cell disorders 

51.07 immune disorders 

30 Iron Deficiency and Other Anemias 

50.01 iron deficiency and other anemias 

51 .08 other blood disease 

31 Dementia 

52.01 senile/presenile psychoses 

52.02 other organic psychotic conditions 

52.03 cerebral degeneration/Alzheimer's disease 

52.04 senility without psychosis 

32 Drug/Alcohol Dependence/Psychoses 

53.01 alcoholic psychoses 

53.02 drug psychoses 

59.01 alcohol dependence 

59.02 dmg dependence 

33 Higher Cost Mental Disorders 

54.01 delinum/delusions/hallucinations 

54.02 hallucinations, symptomatic 
55.01 schizophrenic disorders 

56,01 manic and depressive disorders 

57.01 paranoid states 

57.02 oUier nonorganic psychoses 
60.01 personality disorders 
134.04 suicide/self-inflicted injury 



Concurrent 


HCC 


ADDCG* 


HIerarchv 




Gastrointestinal 



Status for 
Models 



Hierarchy Rule 

If in HCC 21. 22, or 23, then cannot 
be in HCC 24. 



Payment 



Classification 



(?) 
(3) 



Musculoskeletal 



Musculoskeletal 



If in HCC 26 then cannot be 
in HCC 27. 



(3) 
(2) 



(10) 



Hematological 



Hematological 



(3) 



Hematological 



None 



Mental Disorders 



If in HCC 28 then cannot be 
in HCC 29 



If in HCC 28 or 29 then cannot 
be in HCC 30. 



Out 



Out 



10 


(12) 






4 








10 


(12) 










Mental Disorders 


If in HCC 32 then cannot 


10 


(8) 




be in HCC 33. 


4 


(5) 






3 








3 








4 








1 


(3) 







14 



dcs'-ftTaiMao'en- j'.dmD 



TABLE H-3 

CONCURREm" HIERARCHICAL COEXISTING CONDfTlONS (HCCs) 



HCC 

34 Lower Cost Mental Disorders 

58 01 neurotic disorders 

59 03 non-dependent abuse of drugs 

60.02 sexual disorders 

60.03 psychophysiologic disorders 

60.04 acute reaction to stress 

60.05 adjustment reaction 

60.06 nonpsychotic brain syndrome 

60.07 other depression 
60.06 t»havior disorder 

60.09 developmental/behavioral disorders 

60.10 mental retardation 

60.11 other mental disorders 

35 Quadrlplegja/Paraplegia 

63.03 quadriplegia 

63.04 paraplegia 

36 Higher Cost Neurological Disorders 

62.03 anterior horn cell disease, including Lou Gehrig's 
disease (ALS) 

62.04 other spinal cord disease 

62 05 autonomic nen/e disorder 

63.05 Cauda equina syndrome 

63.06 other paralytic disorders 

63.08 other central nervous system disorders 

66.02 mflammatoryrtoxic neuropathy, including Guillain- 

Barre syndrome 
66.04 muscular dystrophies 
67.01 cerebral cysts, compression, edema, anoxic damage 

other brain conditions 
95 05 paralysis of vocal cords/larynx 

37 Other CostJier Neurological Disorders 

63 01 multiple sclerosis, other central nervous system 

dymelination 
64.01 epilepsy and other seizure disorders/convulsions 
66 03 myoneural disorders/myasthenia gravis 

3B Other Neurological Disorders 

62.01 Parkinson's disease 

62.02 Huntington's Disease, other abnormal movement 
disorders 

62.06 Other hereditary and degenerative 
central nervous system diseases 

63.02 infantile cerebral palsy 

65 01 tngemmat nerve disorder 

65.02 facial nerve disorders, including Bell's Palsy 

65.03 root/plexus disorders 

65.04 root/plexus lesions 

65.05 other cranial nerve disorders 

65.06 neuropathy of upper limb 

65.07 neuropathy of leg 
66.01 peripheral neuropathy 
66.05 other neuropathy 

1 1 9,01 spina bifida, other congenital anomalies 
of nen^ous system 

39 Respiratory Arrest 

1 05-02 respiratory arrest 

40 Heart Arrest/ShocK 

79.01 heart arrest/shock 

41 Acute Myocardial Infarction (Heart Attack) 

72.01 acute myocardial infarction (heart attack) 

42 Other High-Cost Acute Heart Disease 
73.01 other acute ischemia 

78,01 ventric tachycardia 

81.01 pencarditis, post-MI 

81 .02 acute endo/myocarditis 

43 Congestive Heart Failure 

75.02 other pulmonary heart disease 
80.01 heart failure 

81 .03 cardiomyopathy/myocarditjs 

44 Atrial Arrhythmia 

77 01 atrial arrhythmia 



Concurrent 


HCC 
Hierarchv 

Mental Dlsonders 


Hierarchv Rule 
If in HCC 32 or 33, then cannot 


Status for 
Models 


ADDCO- 


Pavment Classification 

Cut 



be in HCC 34 



17 



(12) 
(8) 



Nervous System 



Nen«)us System If in HCC 35. cannot be 
in HCC 36. 



3 


(8) 


3 


W 


2 


W 


3 


(8) 


4 


(5) 


3 




1 


(2) 


4 


(8) 



w 



Nervous System 



Nenrtjus System 



If in HCC 35 or 36. t.'ien cannot 
be in HCC 37 



If in HCC 35. 36. or 37. then 
cannot be in HCC 38 



Cardio-Respiratofy 
Arrest 

Cardio-Respiratoiy If in HCC 39, then cannot be 
(8) Anest in HCC 40, 

Heart 



Out 



(8) 
(8) 



(2) 



Heart 



If in HCC 41, cannot be in 
HCC 42. 



If in HCC 41 or 42, then cannot 
be in HCC 43 



If in 41 or 42 or 43, then cannot 
be in HCC 44 



iC3'nra."iTacle(v3',diT,D 



TABLE H-3 

CONCURRErrr hierarchical coexisting CONOmONS (HCCs) 



HCC 

45 Valvular Heart Disease 

68.01 rheumatic fever/heart disease 

68 02 mitral or aortic valve/endocardia disease 
68 03 mitral/aortic valve disorders 

46 Coronary Artery Disease 

71 01 myocardial infarction 

71.02 old myocardial infarcton 

71 .03 other chronic ischemic heart disease 
74 01 angina pectoris 

47 Other Heart Disorders 

76 01 conduction disorders/cardiac dysrhythmias 

119 03 congenital anomalies of cardiac/circulatory systems 

48 Hypertensive Heart Disease 

69.02 hypertensive heart disease 

70 02 malignant hypertensive heart disease 

70.03 hypertensive heart and renal disease 
70 05 hypertension encephalopathy 

49 Heart Disease, Miscellaneous 
76.02 premature heart beats 

81 04 cardiomegaly (enlarged heart) 
81 .05 other heart disease 

50 Hypertension {High Blood Pressure) 
69.01 essential hypertension 

70.01 malignant hypertension 

70.04 secondary hypertension 

51 Hemiplegia/Aphasta 

84.02 hemiplegia (paralysis of one side of body) 

84.03 aphasia (loss of language skills/comprehension) 

52 Cerebral Hemorrhage 

82.01 cerebral hemorrhage 

53 Cerebrovascular Disease 

5 02 cerebrovascular disease late effects 

83-01 precerebral arterial occlusion 

54 01 cerebrovascular accident (stroke) 

85 01 transient cerebral ischemia 

54 Gangrene 

69.07 gangrene 

55 Higher Cost Vascular Disease 
87 01 aortic aneurysm 
87-02 other aneurysm 

88-01 arterial embolism and thromtjosis 
89 06 vascular insufficiency of intestines 

56 Other Vascular Disease 

86 01 atherosclerosis of major vessel 

86.02 atherosclerosis/general, ascvd 
89.01 specified penpheral vascular disease 

89 02 Raynaud's syndrome 

89.03 penpheral vascular disease 

89.04 other arterial disease 

69.05 disease of capillanes 

90.01 phlebitis and thrombophlebitis 

90.02 noninfectious lymphatc disorders 

90 03 hemorrhage nos 
90.04 compression of vein 

91.01 hypotension (low blood pressure) 

92.01 superficial phlebitis-leg 

92.02 vancose veins 

92 03 other circulatory disease/postphlebitic syndrome 

92 04 other specified circulatory disorders 

57 Severe Acute Lung Conditions 
75 01 pulmonary embolism 

103 01 pleurisy/pneumothorax 

104 03 acute lung edema nos 

104.04 post trauma/surgery pulmonary insufficiency 
105.01 respiratoryfailure 

58 High Cost Pneumonia 

99 01 gram-negative/staphyioccocus pneumonia 
102 02 aspiration pneumonia 



Concurrent 
ADDCG- 




HCC 
Hierarchv 


Hierarchv Rule 


3 

1 
3 






Heart 


If in HCC 41 - 44, then 
cannot be in HCC 45 


W 








1 
3 
1 
1 


(1) 




Hurt 


If in HCC 41 . 44, then 
cannot be in HCC 46 


1 
1 






Heait 


If in HCC 41-46. cannot be 
in HCC 47 


1 
1 
1 

3 






Heart 


If in HCC 41-47, cannot be 

in HCC 48, 


1 
3 

1 


(■1) 




Heart 


If in HCC 41-48, cannot be 
in HCC 49 




1 






Heart 


If in HCC 41-49, cannot be 
in HCC 50 


14 

14 




Cerebrovascular 




6 


(8) 


Ce 


>brovascular 


If in HCC 51, cannot be 
HCC 52. 



Status for 
r^odels 



Payment 



Out 



Classification 



Out 



Cerebrovascular 



(3) 



23 



3 

3 (8) 

5 (8) 

8 



If in HCC 51 or 52, cannot be 
in HCC 53 



If in HCC 54, cannot be in 
HCC 55. 



If m HCC 54 or 55, cannot be 
in HCC 56, 



(3) 
(3) 



8 


(12) 


10 


(12) 


17 


(20) 


40 




6 


(8) 


23 


(20) 


23 


(27) 



Lung 



Lung 



3:5'.f-iar.'ableH-3\^^C 



TABLE H-3 

CONCURRENT HIERARCHICAL COEXISTING CONOmONS (HCCs) 



HCC 



59 



Moderate Cost Pneumonia 

100.01 pneumococcal and other specific bacterial pneumoni 

104.01 empyema/abscess 

60 Other and Unspecified Pneumonia 
98.01 viral pneumonia 

100.02 other and unspecified pneumonia 

61 Chronic Lung Disease 

96,01 emphysema/chronic bronchitis 
101.01 asthma 

102.01 bronchiectasis/lung disease due to specified external 
agents (e.g.. black lung disease) 

102.03 respiratory conditions due to other and unspecified 
external agents/post inflammatory fibrosis 

62 Other Lung Disease 

97.01 other bronchitis 

98.02 influenza 

1 04.02 pulmonary congestjon/hypostasis 
1 04.05 other tung disease 

63 High Cost eye Disorders 

93 03 endophthalmitis (eye inflammation) 
93 08 vitreous hemorrhage 

64 Other Eye Disorders 
93.04 retinal disorders 
93 05 glaucoma 

93.06 cataract/lens replacement 

93 09 other eye disorders 

1 19.02 congenital anomalies of eye 

65 Ear. Nose, Mouth, and Throat Disorders 

94 03 vertiginous syndromes 

(eg, vertigo, Meniere's disease) 
94.04 heanng loss 

94 05 other ear disorders 

95 02 nasal polyps/allergic rhinitis (eg . hay fever) 

95.03 chronic sinusitis 

95.04 larynxA'Ocal cord diseases 
95.06 disorders of teeth, gum, and jaw 

(eg. periodontitis, gingivitis) 
95 07 other diseases of upper respiratory system 
95.08 salivary gland diseases 
95 09 other oral soft tissue/tongue/jav^ disorders 

66 Low Cost Eye. Ear, Nor and Throat Disorders 

93 07 disorders of refraction and accommodation 
(e.g.. far-, near-sightedness, astigmatism) 

94.01 impacted eanwax 

94.02 otitis media (middle ear infection) 

95.01 acute nose/throat infection (e g., common cold) 

67 Acute Renal Failure 

106 02 acute renal failure 

68 Other Renal Failure 

106.01 nephritis, dialysis encounter 

106.03 chronic renal failure 

106.04 renal failure, unspecified 

63 Other Urinary System Disorders 

106.05 impaired renal function 
107.01 kidney infection 

1 08.01 renal/ureteral/bladder calculus 
109 01 urethral stncture 

109.02 hydronephrosis/other renal/urethral disorders 
1 1 0.01 other unnary tract infections 

1 1 1 01 other urinary disorders 

70 Genital Disorders 

112.01 hyperplasia of prostate 

112.02 other prostatic disorders 

112.03 penis/teslis/male genital organs disorders 
1 1 3.01 diseases of fema, . pelvic organs 
11302 vaginal and cervical diseases 

113.03 other diseases of female genital organs 

1 1 3.04 female stress incontinence 

1 13.05 menopausal and postmenopausal disorders 
1 14 01 genital prolapse 



Concum 


nt 


HCC 
Hierarehv 


Hierarchy Rule 


Status for 
Models 


ADDCG' 


Payment Classification 


6 
3 


(8) 


Lung 


If in HCC 58, then cannot be 
in HCC 59 




3 

1 




Lung 


If in HCC 58 or 59, cannot be 
in HCC 60. 


Out 


1 

1 
1 




Lung 







27 



(3) 



(2) 



Lung 



If in HCC 57.61 . cannot be 
in HCC 62. 



Bye, Ear, Nos«, and 
(3) Throat 



Eye. Ear, Nose, and If in HCC 63. cannot be 
Throat in HCC 64. 



Eye, Ear, Nose, and 
Throat 



Eye, Ear, Nose, and 
Throat 



Urinary 



If in HCC 63 - 65, cannot be 
in HCC 66. 



(5) 
(1) 



P) 



Urinary If in HCC 67, then cannot be 

in HCC 68, 



Urinary If in HCC 67 or 68. cannot be 

in HCC 69, 



(2) 



ccg'.fna^,TaDierv3\dmb 



TABLE H-3 

CONCURREfJT HIERARCHICAL COEXISTING CONOmONS (HCCs) 



HCC 

71 Pregnancy/Perinatal Conditions 

115.01 pregnancy/birth complications, mother/child 

115.02 pregnancy with abortive outcome 

1 1 5.03 normal pregnancy/delivery 

72 Chronic Ulcer of Skin 

1 1 7,01 chronic ulcer of skin 

73 Other Dermatological Disorders 

116.01 cellulitjs/abscess/other local skin infection 

1 16.02 bullous dermatoses 

1 18.01 dermatitis due to substances taken internally 
(eg . food, dnigs) 

116.02 psohasis and similar disorders 

118.03 other dermatosis 

118.04 diseases of nail (e.g., ingrown toenail) 

118.05 other dermatological disorders 
1 1 9.05 congenital anomalies of skin 

74 Vertebral Fractures 

1 26.01 vertebral fracture without spinal cord injury 

126.02 vertebral fracture with spinal cord injury 

75 Hip Fracture/Dislocation 
128,01 pelvic fracture 

129.01 femoral fracture 
13102 dislocation of hip 

76 Higher Cost Injuries and Poisonings 

127 01 fractures of skuil/face 

131 03 dislocation of knee, including cartilage/meniscus tear 

1 32.02 injury to heart/lung/mtrathoracic organs/blood 
vessels of thorax 

1 32 03 gastrointestinal/liver/kidney/spleen/pelvis injury 
132 07 traumatic amputation of limb/hand/foot/toe 

135 01 intracranial injury 

1 36 01 third degree bums 

1 36 04 early complications of trauma 

1 37 01 accidental poisoning by prescription or over-the- 

counter medications^ bio logical substances, 
including medication en'ors 

77 Lower Cost Injuries and Poisonings 

5 03 injury late effects 

1 27.02 fractures of nasal bone 

130 01 fractures of lower limb 

131 01 shoulder dislocation 
131 04 other dislocations 
131 05 fracture of nb, closed 

131 06 hand/wrist/lower arm fracture 
13107 other fractures 

132,01 foreign body in pharynx/larynx 

132.04 open wound of eye 

132 05 open wound/injury of lower arm 

1 32 06 open wound of other sites 

132.08 crushing injury 

132.09 foreign body in eye/ear/nose 

133 01 sprains 

134.01 concussion 

134 02 contusion/superficial injury 
134 03 accidental falls 

134.05 other accidents 
136 02 other bums 

136.03 nerve injury 

137.02 toxic effects, named substance 

137.03 toxic effects of other nonmedicinal substances 

137.04 allergy, unspecified 

1 37.05 adverse effects of correctly prescribed and 
administered drugs in therapeutic use 

78 Complications of Medical and Surgical Care 

138 01 malfunction of internal orthopedic device/graft 
138 02 infection/inflammation due to internal device/graft, 

transplant failure/rejection 
138 03 other complications of certain specified 

medical procedures 
13804 other complications of medical and 

surgical procedures, nee (eg, post-operative infection) 
1 33 05 misadventure or abnormal reaction/complication 

of patient dunng surgery or medical care 



Concurrent 
ADPCQ' 



17 



4 
27 

14 

14 
17 



(2) 



(0) 

(1) 



(5) 



(4) 
(12) 



HCC 
Hierarchy 

None 



Skin 



Skin 



Hierarchy Rule 



Status for 
Models 



Payment 



Classification 



If in HCC 72. cannot be 
HCC 73 



Out 



Out 



Injury 



Injury 



Injury 



3 


(2) 


2 




3 


(1) 


3 


(1) 


4 


(5) 


3 


(1) 


5 




1 


(3) 


3 





Injury 



W 



(2) 



If in HCC 74-76, cannot be in 
HCC 77. 



Out 



(0) 



(?) 



Out 



dcg'find:\Tafcleh-3'.d'p& 



TABLE H-3 

CONCURRENT HIERARCHICAL COEXISTING CONDITIONS (HCCs) 



Concurrent 

HCC ADDCO* 

79 Coma 

121.01 coma 8 

80 Major Symptoms 

63 07 nervous/muscu'oskeletal system symptoms 1 

121 .02 syncope (fainting) and collapse 3 
122.01 fever 3 
123-01 dyspnea (labored breathing)/other respiratory 1 

abnormalities 

123 02 hemoptysis (coughing up blood) 1 
123.04 respiratory/other chest symptoms 1 
124.01 chest pain 1 

125.01 retention of urine 5 

125.02 incontjnence/urethral discharge 1 
125,04 abdominal/pelvis symptoms 1 

81 fviinor Symptoms, Signs, Findings 

61,01 headaches 1 

119.06 chromosomal anomalies 

119 07 other congenita! anomalies 1 

120 01 somatic/segmental dysfunction 1 
120 02 dizziness and giddiness 1 

120.03 malaise and fatigue 1 

1 20.04 other general symptoms 1 
123,03 cough 1 

124 02 other cardiovascular symptoms 1 

125 03 other urinary system symptoms 1 
1 43 01 infectious disease contact/earner 

1 43.07 problems of internal organs/eirternal sites 2 
143 13 household/family/other psychosocial circumstances 3 
143,14 care not delivered 3 



HCC 

Hierarchy 



None 



Status for 
Models 



Hierarchy Rule 



Payment Classification 



Out 



Gut 



PROCEDURES, AND FACTORS INFLUENCING CONTACT WITH HEALTH SERVICES 



82 Heart. Lung. Kidney. Liver Transplant 
P9 heart, lung, kidney, liver transplant 

83 Heart. Heart Valve, Kidney. Lung. Liver Transplant (staUis/history) 

1 39 01 kidney, heart, heart valve (human/animal tissue), 3 

lung, liver transplant 

84 Other Organ Transplant/Replacement 

139 02 other organ transplant 

139 03 heart, heart valve replacement by artificial device 

139 04 joint replacement 

139 05 other organ replacement 

85 Tracheostomy 

P5 tracheostomy 

86 Gastrostomy 
P3 gastrostomy 

87 Enterostomy 
P4 enterostomy 



88 Artificial Opening Status/Attention 
139,06 artificial opening status/attention 

89 Machine Dependence 
139,09 aspirator, respirator, other machine dependence 40 
PI intubation/mechanical ventilation 



Transplant 
Transplant 

None 



If in HCC 82. then cannot be in 
in HCC S3 



3 
8 
3 


Artificial Opening, 
Tracheostomy 

Artificial Opening 
Artificial Opening 




e 


Artificial Opening 


If in HCC 85.87. then cannot be 
in HCC 88 




Tracheostomy 


If in HCC 85. then cannot be 



in HCC 89. 



Post-Surgical States/Aftercare/Rehabilitation Procedures 

139 07 postsurgical states, eye 

139,08 other postsurgical states, including dialysis status 

140,01 rehabilitation procedures 

143 08 elective surgery 

143 09 prosthesis/other device fitting, adjustment 

1 43 1 other orthopedic aftercare 

143.11 aftercare 

143.12 donor 

Chemotherapy 

1 42.01 chemotherapy 

P8 chemotherapy 

Radiation Therapy 

1 41 .01 radiation therapy 

P10 radiation oncology 



6 






3 






14 






3 






3 






3 






1 






14 






4 


Chemo-ZRadio- 
Therapy 






Chemo-ZRadio- 


If in HCC 91. then cannot be in 


6 


Therapy 


in HCC 92. 



Ccs'.finar.Tafcterv 3\a.Tit3 



TABLE H-3 

CONCURRENT HIERARCHICAL COEXISTING CONOmONS (HCCs) 



HOC 

93 Venous Access Port 

P7 venous access port 

94 Dialysis 

P2 dialysis 

95 Surgical Amputations 

P6 surgical amputations 

96 Preventive/Screening/Observation/Special Exams 

143.02 vaccination, medical exam, other preventive 

1 43. 1 5 administrative/consultation 

143.16 screening for malignant neoplasm 

143.17 screeningyobservation/special exams 

97 History of Disease 

1 43.03 history of malignant neoplasm 

143.04 history of mental disorder/other disease 

143.05 history of drug aHergy/other health hazard 

143.06 family history of disease 

PRINCIPAL HOSPrTAL INPATIENT DIAGNOSTIC GROUPS 



Concurrent 
ADDCQ' 



HOC 
Hierarchy 



Status for 
Models 



Hierarchy Rule 



Payment 



Classification 



None 



Out 



98 Highest Incremental Cost Principal Inpatient Diagnoses 

2 Moderate Cost In.'ectious Diseases 

4 Metastatic Cancer 

5 High Cost Cancers 

19 Liver Disease 

35 Quadnplegia/Paraplegia 

41 Acute Myocardial Infarction (Heart Attack) 

45 Valvular Heart Disease 

51 Hemiplegia/Aphasia 

52 Cerebral Hemorrhage 

55 Higher Cost Vascular Disease 
72 Chronic Ulcer of Skin 

99 High Incremental Cost Principal Inpatient Diagnoses 

6 Moderate Cost Cancers 

9 Uncertain Neoplasm 

20 Cin-hosis 

25 Bone and Joint Infections 

26 Rheumatoid Arthritis and Connective Tissue Disease 

27 Other Musculoskeletal and Connective Tissue Disonders 
29 Blood/Immune Disorders 

33 Higher Cost Mental Disorders 

40 Heart Arrest/Shock 

42 Other High-Cost Acute Heart Disease 

46 Coronary Artery Disease 
54 Gangrene 

57 Severe Acute Lung Conditions 

75 Hip Fracture/Dislocation 

100 Moderate Incremental Cost Principal Inpatient Diagnoses 

3 Other Infectious Disease 

7 Lower Cost Cancers 

8 Carcinoma in Situ 

10 Skin Cancer, except Melanoma 

11 Benign Neoplasm, Except Breast 

12 Benign Neoplasm of Breast/Other Breast Disorders 

13 Diabetes With Complications 

1 4 Diabetes Without Complicabons 

21 Peritonitis 

22 High Cost Gastrointestinal Disorders 

23 Moderate Cost Gastrointestinal Disorders 
23 Aplastic Anemia 

31 Dementia 

32 Drug/Alcohol Dependence/Psychoses 

36 Higher Cost Neurological Disorders 
38 Other Neurological Disorders 

43 Congestive Heart Failure 

47 Other Heart Disorders 

53 Cerebrovascular Disease 

56 Other Vascular Disease 

58 High Cost Pneumonia 
61 Chronic Lung Disease 
68 Other Renal Failure 

76 Higher Cost Injuries and Poisonings 

78 Complications of Medical and Surgical Care 

91 Chemotherapy 

92 Radiation Therapy 



dcg\firaMaciefi-3\dmb 



TABLE H-3 

CONCURREMT HIERARCHICAL COEXJSTING CONOmONS (HCCs) 



HCC 



Concurrent 
ADDCO' 



HCC 
Hierarchy 



Hierarchy Rule 



Status for 
Models 



Payment 



Classification 



101 Lower Incremental Cost Principal Inpatient Diagnoses 

1 SeptJcemi a/Shock 

16 Other Higher Cost Endocnne, Metabolic, Nutritional Disorders 

17 Other Lower Cost Endocrine. Metabolic. Nutritional Disorders 
24 Other Gastrointestinal Disorders 

30 Iron Deficiency and Other Anemias 

34 Lower Cost Mental Disorders 

37 Other Costlier Neurological Disorders 

39 Respiratory Arrest 

44 Atrial Arrtiythmia 

48 Hypertensive Heart Disease 

50 Hypertension (High Blood Pressure) 

59 Moderate Cost Pneunnonia 

60 Other and Unspecified Pneumonia 

62 Other Lung Disease 

63 High Cost Eye Disorders 

64 Other Eye Disorders 

69 Other Unnary System Disorders 

70 Genital Disorders 

73 Other Dermatological Disorders 

74 Vertebral Fractures 

77 Lower Cost Injuries and Poisonings 

79 Coma 

88 Artificial Opening Status/Attention 

102 Lowest Incremental Cost Principal Inpatient Diagnoses 



49 

65 



67 
71 



Heart Disease, Miscellaneous 

Ear. Nose. Mouth, and Throat Disorders 

Low Cost Eye. Ear, Nose, and Throat Disorders 

Acute Renal Failure 

Pregnancy/Pennatal Conditions 



103 Other Principal Inpatient Diagnoses 

15 Protein -Calorie Malnutrition 

18 High Cholesterol 

80 Major Symptoms 

81 Minor Symptoms, Signs, Findings 

83 Heart, Heart Valve, Kidney. Lung, Liver Transplant (status/history) 

84 Other Organ Transplant/Replacement 

89 Machine Dependence 

90 Post-Surgical States/Aftercare/Rehabilltation Procedures 
95 Preventrve/Screening/Observation/Special Exams 

97 History of Disease 

OTHER RISK FACTORS 



Out 



104 AgeySex 



Female. Younger than 65 
Female: 65-69 
Female: 70-74 
Female: 75-79 
Female- 80-84 
Female: 85 or older 
Male: Younger than 65 
Male: 65-69 
Male: 70-74 
Male: 75-79 
Male: 80-84 
Male: 85 or older 



• Numbers in parenthes« ndtcat* DCGs assigned excluding symptom, V-code. and compCcattont of me<*caV«xgicaJ car* DXG». 
These DCGs are stwwn onfy wtiere (ftfTerent. 



SOURCE: 1992 (Diagnoses) and 1992 (Experaaures) Medicare clains. 



10 

d:gifina/\Ta£)lefv3\dmb 



TABLE H-4 

HIERARCHICAL COEXISTING CONDITIONS CONCURRENT MODEL PARAMETER ESTIMATES 



HOC 


DESCRIPTIVE LABEL 


— 


INTERCEPT 


1 


SepticemJa/Shock 


2 


Moderate Cost Infectious Diseases 


3 


Other Infectious Disease 


4 


Metastatic Cancer 


5 


High Cost Cancers 


6 


Moderate Cost Cancers 


7 


Lower Cost Cancers 


8 


Carcinoma in Situ 


9 


Uncertain Neoplasm 


10 


Skin Cancer, except Melanoma 


11 


Benign Neoplasm, Except Breast 


12 


Benign Neoplasm of Breast/Other 




Breast Disorders 


13 


Diabetes With Complications 


14 


Diabetes Without Complications 


15 


Protein-Calorie Malnutrition 


16 


Other Higher Cost Endocrine, Metabolic, 




Nutritional Disorders 


17 


Other Lower Cost Endocrine, Metabolic, 




Nutritional Disorders 


18 


High Cholesterol 


19 


Liver Disease 


20 


Cirrhosis 


21 


Peritonitis 


22 


High Cost Gastrointestinal Disorders 


23 


Moderate Cost Gastrointestinal Disorders 


24 


Other Gastrointestinal Disorders 


25 


Bone and Joint Infections 



202 



HCCP-C MODEL 


HCCP PAYMENT MODEL 


HCC-C MODEL 


(R^= 


.5250) 


(R^ = 


.4782) 




(R^= 


.4704) 


COEFF. 


STD. ERR. 


COEFF. 


STD 


.ERR. 


COEFF. 


STD. ERR. 


-319 


29 • 


193 




26* 


-278 


30 * 


6,622 


80* 


8.087 




84* 


7,597 


85* 


3,447 


71 * 


4,939 




74* 


3,568 


75 ' 


52 


27 


— 




— 


-17 


29 


5,175 


75* 


5,971 




77* 


8,109 


73* 


2,541 


83* 


3,174 




86* 


3,491 


87 * 


713 


60* 


1,352 




62* 


1,621 


62 * 


212 


42* 


741 




42* 


855 


43 * 


97 


173 


- 




— 


154 


183 


194 


SO* 


- 




— 


235 


53* 


-104 


61 


— 




— 


73 


64 


73 


44 


- 




— 


125 


46 • 


-336 


36* 


~ 




- 


-264 


38 • 


1,634 


46* 


2,068 




48* 


1,670 


48 * 


106 


30* 


— 




~ 


83 


31 * 


5,068 


97* 


6,393 




101 • 


7,052 


100* 


2,884 


37* 


— 




— 


2,892 


39 • 



30 



216 



31 



-312 


26* 


- 


— 


-345 


28 


4,723 


194 • 


5,603 


203 • 


5,374 


205 


669 


166 • 


1,212 


174 • 


427 


176 


9,119 


221 ■ 


11,586 


231 • 


12,465 


232 


3,514 


57* 


5,200 


58* 


3,840 


60 


1,444 


60* 


2,415 


61 * 


1,497 


63 


203 


23 * 


— 


- 


241 


24 


2,473 


109 • 


3,459 


113 • 


2,973 


114 



1 

dcg\fJnal\Tableh-4\nab 



TABLE H-4 

HIERARCHICAL COEXISTING CONDITIONS CONCURRENT MODEL PARAMETER ESTIMATES 



HCC 
26 

27 

28 
29 
30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 
51 
52 



DESCRIPTIVE LABEL 

Rheumatoid Arthritis and Connective 

Tissue Disease 

Other Musculoskeletal and Connective 

Tissue Disorders 

Aplastic Anemia 

Blood/Immune Disorders 

Iron Deficiency and Other Anemias 

Dementia 

Drug/Alcohol Dependence/Psychoses 

Higher Cost Mental Disorders 

Lower Cost Mental Disorders 

Quadriplegia/Paraplegia 

Higher Cost Neurological Disorders 

Other Costlier Neurological Disorders 

Other Neurological Disorders 

Respiratory Arrest 

Heart Arrest/Shock 

Acute Myocardial Infarction (Heart Attack) 

Other High-Cost Acute Heart Disease 

Congestive Heart Failure 

Atrial Arrhythmia 

Valvular Heart Disease 

Coronary Artery Disease 

Other Heart Disorders 

Hypertensive Heart Disease 

Heart Disease, Miscellaneous 

Hypertension (High Blood Pressure) 

Hemiplegia/Aphasia 

Cerebral Hemorrhage 



HCCP-C MODEL 
(R^=.5250) 


HOOP PAYMENT MODEL 
(R^ = .4782) 


HCC-C MODEL 
(R^=.4704) 


COEFF. STD. ERR. 
396 55 * 


COEFF. STD. ERR. 
1,008 56 • 


COEFF. STD, ERR. 
462 58 ♦ 



-30 



20 



83 



21 * 



5,654 


161 • 


6,019 


168 • 


6,674 


169 


2,050 


59* 


2,720 


62* 


2,575 


63 


1,331 


32* 


- 


— 


1,443 


34 


254 


46* 


- 


— 


70 


49 


3,833 


101 • 


4,567 


105* 


3,883 


106 


1,936 


43 * 


2,472 


43* 


1,873 


45 


175 


36* 


~ 


— 


126 


38 


5,206 


188 • 


6,552 


197 * 


6,254 


199 


2,455 


58* 


3,270 


60* 


3,070 


61 


761 


60* 


1,149 


62* 


748 


63 


331 


43* 


— 


— 


391 


45 


9,639 


136 * 


- 


— 


16,639 


139 


4,336 


105 • 


- 


— 


5,399 


110 


9,004 


85- 


11,926 


86* 


9,645 


89 


4,756 


52' 


6,857 


51 * 


5,327 


55 


1,227 


35* 


2,340 


34* 


1,424 


37 


583 


54* 


1,348 


55* 


842 


57 


403 


60* 


1,155 


62* 


588 


63 


-49 


30 


~ 


— 


133 


32 


104 


55 


— 


— 


232 


58 


33 


67 


— 


— 


36 


70 


155 


79 


— 


— 


291 


84 


-46 


25 


— 


— 


-26 


26 


6,414 


82- 


7,818 


85* 


7,188 


86 


3,130 


135 • 


3,876 


141 • 


3,486 


142 



dcg\final\Tableh-4\nab 



TABLE H-4 

HIERARCHICAL COEXISTING CONDITIONS CONCURRENT MODEL PARAMETER ESTIMATES 



HOC 


DESCRIPTIVE LABEL 


53 


Cerebrovascular Disease 


54 


Gangrene 


55 


Higher Cost Vascular Disease 


56 


Other Vascular Disease 


57 


Severe Acute Lung Conditions 


58 


High Cost Pneumonia 


59 


Moderate Cost Pneumonia 


60 


Other and Unspecified Pneumonia 


61 


Chronic Lung Disease 


62 


Other Lung Disease 


63 


High Cost Eye Disorders 


64 


Other Eye Disorders 


65 


Ear, Nose, Mouth, and Throat Disorders 


66 


Low Cost Eye, Ear, Nose, and 




Throat Disorders 


67 


Acute Renal Failure 


68 


Other Renal Failure 


69 


Other Urinary System Disorders 


70 


Genital Disorders 


71 


Pregnancy/Perinatal Conditions 


72 


Chronic Ulcer of Skin 


73 


Other Dermatological Disorders 


74 


Vertebral Fractures 


75 


Hip Fracture/Dislocation 


76 


Higher Cost Injuries and Poisonings 


77 


Lower Cost Injuries and Poisonings 


78 


Complications of Medical and 




Surgical Care 


79 


Coma 



HCCP-C MODEL 


HCCP PAYMENT MODEL 


HCC-C MODEL 


(R^= 


.5250) 


(R^ = 


.4782) 


(R^= 


.4704) 


COEFF. 


STD. ERR. 


COEFF. 


STD. ERR. 


COEFF. 


STD. ERR. 


911 


34 * 


1,526 


35* 


971 


36* 


7,061 


152 * 


7,849 


159 * 


10,223 


144 * 


2,998 


64 * 


3,931 


66 • 


3,341 


68 * 


575 


27 • 


— 


— 


662 


28 * 


4,344 


43 * 


5,927 


44 * 


5,263 


45* 


7,676 


99 • 


8,144 


103* 


9.277 


104 * 


2,690 


119 • 


2,990 


124" 


2,645 


126 * 


1,444 


43 • 


— 


— 


1,548 


46 * 


734 


27 * 


1,277 


28 • 


727 


29 * 


262 


33 • 


— 


— 


295 


35 * 


511 


165 * 


1,011 


172* 


543 


174 * 


-120 


19 * 


— 


— 


-98 


20 * 


-195 


26 • 


— 


— 


-135 


28 • 


-403 


39- 


- 


- 


-410 


41 * 


6,851 


126- 


8,356 


131 • 


10,172 


129 * 


1,655 


78- 


2,444 


81 * 


1,848 


82* 


522 


26 • 


— 


~ 


504 


27 * 


-13 


25 


~ 


— 


26 


26 


1,303 


111 * 


- 


1 


1,437 


117 * 


1,892 


55 * 


2,442 


57* 


1,914 


59 * 


-87 


22 * 


~ 


— 


-95 


23 * 


1,193 


93- 


1,730 


97 * 


1,329 


98 • 


4,342 


66 • 


6,785 


67 * 


5,176 


69 • 


2,007 


57 • 


2,914 


59 • 


2,553 


60 * 


90 


24 • 


— 


— 


222 


25* 


6,670 


50' 


— 


— 


8,454 


52 * 



2,599 



132 



3,440 



139 



3,363 



140 



dcg\final^'^ableh-4\nab 



TABLE H-4 

HIERARCHICAL COEXISTING CONDITIONS CONCURRENT MODEL PARAMETER ESTIMATES 



HCC DESCRIPTIVE LABEL 

80 Major Symptoms 

81 Minor Symptoms, Signs, Findings 

82 Heart, Lung, Kidney, Liver Transplant 

83 Heart, Heart Valve, Kidney, Lung, 
Liver Transplant (status/history) 

84 Other Organ Transplant/Replacement 

85 Tracheostomy 

86 Gastrostomy 

87 Enterostomy 

88 Artificial Opening Status/Attention 

89 Machine Dependence 

90 Post-Surgical States/Aftercare/ 
Rehabilitation Procedures 

91 Chemotherapy 

92 Radiation Therapy 

93 Venous Access Port 

94 Dialysis 

95 Surgical Amputations 

96 Preventive/Screening/Observation/ 
Special Exams 

97 History of Disease 

98 Highest Incremental Cost Principal Inpatient Diagnoses 

99 High Incremental Cost Principal Inpatient Diagnoses 

100 Moderate Incremental Cost Principal Inpatient Diagnoses 

101 Lower Incremental Cost Principal Inpatient Diagnoses 

102 Low/est Incremental Cost Principal Inpatient Diagnoses 

103 Other Principal Inpatient Diagnoses 



HCCP-C MODEL 


HCCP PAYMENT MODEL 


HCC-C MODEL 


(R'= 


.5250) 


(R^ = 


.4782) 


(R^= 


.4704) 


COEFF. 


STD. ERR. 


COEFF. 


STD. ERR. 


COEFF. 


STD. ERR. 


691 


22* 


~ 


— 


798 


24* 


173 


21 * 


~ 


— 


262 


22* 


120,188 


1,946 • 


126,486 


2,039 • 


— 


— 


3,175 


319 • 


6,884 


333* 


- 


- 


4,507 


76- 





_ 


^^ 


_ 


59.695 


307 * 


63,513 


315 * 


_ 


... 


5.194 


173 • 


7,303 


180* 


— 


— 


11,571 


332 • 


13,345 


348* 


— 





3,510 


130 • 


5,284 


136 * 


— 


_ 


7,272 


77* 


8,775 


76 * 


— 


_ 


3,833 


40* 


- 


— 


- 


- 


3,416 


98* 


3,843 


103* 


_ 


_ 


-1,136 


135 * 


~ 


_ 





_ 


7,008 


233 * 


8,347 


244 * 


_ 


— 


20,537 


345 ' 


22,274 


361 * 


— 


_ 


12,541 


277 * 


14,509 


290 * 


_ 


_» 


322 


20* 


_ 


•* 


__ 


__ 



431 



40 



dcg\final\Tableh-4\nab 



TABLE H-4 

HIERARCHICAL COEXISTING CONDITIONS CONCURRENT MODEL PARAMETER ESTIMATES 



HCC DESCRIPTIVE U\BEL 

AGE/SEX 
FEMALE, < 65 
FEMALE, 70-74 
FEMALE, 75-79 
FEMALE, 80-84 
FEMALE, 85 OR OLDER 
MALE, < 65 
MALE, 65-69 
MALE. 70-74 
MALE, 75-79 
MALE, 80-84 
MALE. 85 OR OLDER 



HCCP-C MODEL 


HCCP PAYMENT MODEL 


HCC-C MODEL 


(R'= 


.5250) 




(R^ = 


.4782) 




(R^= 


.4704) 


COEFF. 


SID 


. ERR. 


COEFF. 


STD 


ERR. 


COEFF. 


STD. ERR. 


142 




54 ' 


246 




56 * 


155 


57* 


-12 




33 


68 




35 


-51 


35 


-65 




35 


104 




37* 


-123 


37* 


-195 




40 * 


26 




41 


-335 


42* 


-580 




42 • 


-372 




43- 


-857 


45* 


33 




46 


-114 




47* 


49 


48 


102 




37- 


72 




38 


149 


39* 


61 




37 


98 




38 • 


110 


39* 


-31 




41 


93 




42 * 


-16 


43 


-260 




50 * 


-117 




51 • 


-393 


53* 


-454 




61 * 


-235 




63* 


-780 


64* 



* indicates p <= .05 (coefficient is statistically significant) 

NOTE: Omitted age/sex category is female. 65-69. 

SOURCE: 1992 (Expenditures) and 1992 (Diagnoses) IVIedicare claims 



dcg\final\Tableh-4\nab 



APPENDIX I: 

SPECIALTY CODES CONSIDERED 
PHYSICIAN SPECIALTIES 



TABLE 1-1 

1991 SPECIALTY CODES CONSIDERED PHYSICIAN SPECIALTIES 



Specialty Code and Description 

01 General Practice 

02 General Surgery 

03 Allergy/Immunology 

04 Otolaryngology 

05 Anesthesiology 

06 Cardiology 

07 Dermatology 

08 Fannily Practice 

09 Gynecology (Osteo) 

1 Gastroenterology 

11 Internal Medicine 

12 Osteo. Manipulative Therapy 

13 Neurology 

14 Neurosurgery 

15 Obstetrics (Osteo) 

16 Obstetrics/Gynecology 

17 Ear, Nose, Throat (Osteo) 

18 Ophthalmology 

19 Oral Surgery (Dentists only) 

20 Orthopedic Surgery 

21 Path. Anat., Clinical Pathology (Osteo) 

22 Pathology 

23 Peripheral Vascular Disease (Osteo) 

24 Plastic and Reconstructive Surgery 

25 Physical Medicine and Rehabilitation 

26 Psychiatry 

27 Psychiatry, Neurology (Osteo) 

28 Colorectal Surgery 

29 Pulmonary Disease 

30 Diagnostic Radiology 

31 Roentgenology, Radiology (Osteo) 

32 Radiation Therapy (Osteo) 

33 Thoracic Surgery 

34 Urology 



Specialty Code and Description 

35 Chiropractic 

36 Nuclear Medicine 

37 Pediatric Medicine 

38 Geriatric Medicine 

39 Nephrology 

40 Hand Surgery 

41 Optometrist 

44 Infectious Disease 

46 Endocrinology 

48 Podiatry 

66 Rheumatology 

70 Clinic/Other Grp Practice, except GPPP 

76 Peripheral Vascular Disease 

77 Vascular Surgery 

78 Cardiac Surgery 

79 Addiction Medicine 

81 Critical Care (Intensivists) 

82 Ophthalmology-Cataracts Specialty 

83 Hematology/Oncology 

84 Preventive Medicine 

85 Maxillofacial Surgery 

86 Neuropsychiatry 

90 Medical Oncology 

91 Surgical Oncology 

92 Radiation Oncology 

93 Emergency Medicine 

94 Interventional Radiology 

96 Unknown Physician Specialty 

99 Unknown Supplier/Provider 



SOURCE: May 1992 HCFABPO memo. 



dcg\final\Tab-i1Viab 



IIIIIH 



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3 aOiS D001305t, L 



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